Coronary artery disease develops over many years as plaque builds up on the inside of arteries that supply blood to the heart. This buildup narrows and hardens the arteries, making it hard for blood to flow through. As a result, the heart doesn’t get the oxygen and nutrients it needs to function properly.
One of the procedures that can make it easier for blood to flow through your arteries is an atherectomy. During an atherectomy, a doctor clears the clogged coronary artery by removing the hardened plaque with a device called a rotoblade.
This procedure is also called “rotational atherectomy” or “rotational coronary atherectomy.” Rotational atherectomy might be done if an artery has hard plaque with a lot of calcium.
During an atherectomy, you are awake and under local anesthesia. Your doctor inserts a catheter in your artery near your groin or at the bend of your elbow. Using an X-ray machine, the doctor guides the catheter to the narrowed artery.
The doctor then threads another catheter to the site of the blockage. This catheter has the rotoblade on the end, which is a tiny, olive-shaped device coated with microscopic diamond chips. It spins at a high speed, like a drill, breaking up the blockages into tiny pieces. These pieces then pass harmlessly through your blood.
Atherectomy is often done before angioplasty or stent placement.
After an atherectomy, you are moved to a recovery room or to the coronary care unit. Your heart rate, pulse and blood pressure are closely monitored, and the site where the catheter was put in is checked for bleeding.
To prevent bleeding, you may have a large bandage or a compression device on the catheter insertion site. You’ll be told to keep your leg straight if the insertion site is in your groin area. You may receive IV medication, such as blood thinners, to prevent blood clots.
You most likely will start walking six to 24 hours after the procedure and stay in the hospital for one or two days. After several days, you’ll be allowed to exercise and drive.
Risks & Complications
Risks of atherectomy with a rotoblade may include:
- Heart attack during the procedure, although this is rare
- Closing off of the artery, which requires emergency bypass surgery
- Puncturing the artery
- Heart rhythm problems
- Heart tissue damage
Choosing a cardiologist who has experience with the rotoblade procedure reduces the risk of complications.
Studies have shown that removing calcium with the rotoblade procedure is very effective. In some cases, it’s more effective than angioplasty and stenting alone. When calcium is in the way, stents are harder to place and may end up in the wrong position. Removing calcium with a rotoblade before placing a stent allows the stent to be placed correctly.
The most common alternative to atherectomy is angioplasty with stenting. With angioplasty, a small balloon is connected to the catheter. Once the catheter has been guided to the right place in the artery, the balloon is inflated. The pressure from the inflated balloon presses the plaque against the wall of the artery to improve blood flow.
After the plaque is compressed, a stent is inserted into the artery to prop it open.
Ask your doctor if atherectomy or angioplasty is a better choice for your condition.
The rotoblade procedure does not fix the underlying cause of coronary artery disease. Making lifestyle changes is important to your long-term health. Your doctor will probably ask you to:
- Eat a healthy diet
- Lose weight
- Quit smoking
Questions to Ask Your Doctor
- Why are you recommending the rotoblade procedure?
- Will I also need an angioplasty and stenting?
- Are there other treatments for my coronary artery disease?
- What are the risks of the rotoblade procedure?
- What are the goals of treatment?
- How soon after the procedure will I be able to return to my normal activities?
- Will I have to have this or another procedure done again in the future?
- What lifestyle changes should I make?
- Will I need to take any medications after the procedure? For how long?