Introduction:

Rotational atherectomy, also known as rotational or rotational angioplasty, is an innovative and precise catheter-based technique used to treat complex coronary artery disease. This comprehensive article aims to explore the mechanism, indications, procedure, and potential complications of rotational atherectomy, shedding light on its role in managing coronary artery disease.

Mechanism of Rotational Atherectomy:

Rotational atherectomy involves the use of a high-speed rotating burr, also known as a diamond-tipped burr or crown, which is mounted on a flexible catheter. The rotating burr effectively abrades and pulverizes calcified plaque, enabling plaque removal and widening of the narrowed coronary artery lumen. This technique improves blood flow through the affected artery and restores normal coronary function.

Indications for Rotational Atherectomy:

Rotational atherectomy is typically considered for patients with:

• Severely calcified coronary artery lesions: When a coronary artery becomes heavily calcified, it can hinder the effectiveness of conventional balloon angioplasty and stent placement. Rotational atherectomy helps prepare the vessel for successful stent deployment.
• In-stent restenosis: Some patients may experience restenosis, or re-narrowing, of a previously stented artery due to tissue growth within the stent. Rotational atherectomy can facilitate the removal of this tissue and improve stent patency.
• Complex lesions: Rotational atherectomy is particularly useful in treating complex coronary lesions, such as long or diffusely diseased segments, chronic total occlusions, or bifurcation lesions.

The Rotational Atherectomy Procedure:

During the rotational atherectomy procedure:

• Access and guide wire placement: A percutaneous femoral or radial artery access is obtained. A guidewire is then advanced through the coronary artery and passed beyond the narrowed segment.
• Rotational burr insertion: The rotational burr catheter is advanced over the guidewire and positioned at the site of the calcified lesion.
• Rotational ablation: The burr is activated and rotates at high speed, effectively grinding away the calcified plaque. The ablated plaque particles are aspirated by a vacuum system and removed from the body.
• Balloon angioplasty and stent placement: After successful plaque removal, the interventional cardiologist may perform balloon angioplasty to further dilate the artery, followed by stent placement to scaffold the artery and prevent restenosis.

Potential Complications of Rotational Atherectomy:

While rotational atherectomy is generally safe and effective, it may carry certain risks, including:

• Coronary artery dissection: The rotating burr may cause dissection (tearing) of the coronary artery, which may require additional intervention or treatment.
• Vessel perforation: In rare cases, the burr may perforate the arterial wall, leading to bleeding or other complications.
• Slow flow or no reflow phenomenon: During the procedure, impaired blood flow, known as the no reflow phenomenon, may occur due to microvascular damage.
• Coronary artery spasm: The procedure may trigger a spasm in the coronary artery, reducing blood flow.

Conclusion:

Rotational atherectomy is a valuable tool in managing complex coronary artery disease, particularly in cases with severe calcification. It allows interventional cardiologists to effectively prepare the artery for stent placement, promoting improved blood flow and better outcomes for patients with challenging coronary lesions.

Hashtags: #RotationalAtherectomy #CoronaryArteryDisease #CalcifiedLesions #InterventionalCardiology