What is rotational atherectomy?
Over time, the fatty plaque that narrows a heart artery can harden with calcium, almost like bone. Such a hard narrowing is difficult to open with a balloon and a stent alone. Rotational atherectomy uses a tiny, diamond-coated drill ("burr") on the tip of a thin wire. The burr spins at very high speed and gently sands away the hard calcium, turning it into particles so small that they are washed away in the bloodstream. This prepares the artery so that a balloon and stent can then be used.
Why is it done?
It is used when a narrowing is so heavily calcified that a balloon cannot cross it or can not open it properly. A stent that does not expand fully is more likely to narrow again or block, so opening the artery with atherectomy first gives a better, longer-lasting result.
What happens on the day?
The procedure is done in the catheterisation laboratory, in the same way as a coronary angiogram and PCI. After local anaesthetic, a thin tube is placed in the artery at the wrist or groin and guided to the heart. A very fine wire is passed across the narrowing and the burr is advanced over it in short, careful drilling motions. A stent is then placed. Sometimes a temporary pacemaker wire may be used, as the heart rate can slow briefly during treatment.
What to expect afterwards
You are monitored in the ward, and the puncture site is checked regularly. Most patients stay one night and go home the next day.
Possible complications
Because it is used for the most difficult, calcified arteries, the risks are somewhat higher than for a routine balloon or stent, although serious problems are uncommon. Possible complications include bruising or bleeding at the puncture site, a temporary slow heart rate, a tear or spasm of the artery, slow blood flow in the artery, damage to the artery wall and rarely, a heart attack, stroke or the need for emergency surgery.
This information does not replace a consultation. Please discuss your own risks and options with your cardiologist.