Over time, plaque, a fatty substance made up of cholesterol, calcium and other materials, can build up in our arteries. When an artery becomes blocked by plaque, it can cause a heart attack, stroke or painful blockages in the blood vessels of the legs. If plaque is soft enough, an interventional cardiologist can insert a thin tube with a tiny balloon at the end into the artery and open the balloon to push aside the plaque and reopen the artery for blood flow. This procedure is called angioplasty.
But what if the plaque is too hard for angioplasty? That is where rotablation, or rotational atherectomy, comes in.
As calcium builds up in the artery walls, plaque can become extremely rigid and hard – too hard for an angioplasty balloon to stretch the artery open. To solve this problem, rotablation can be used to clear an artery. The rotablator is a device inserted into the artery through a tube known as a catheter. Once in the blood vessel, the rotablator spins between 140,000 and 200,000 revolutions per minute. A diamond-tipped burr on the head of the device breaks up plaque inside the artery. This procedure is known as rotational atherectomy.
Rotablation is especially helpful in breaking up calcified areas that build up around previous bypass grafts or procedure sites. It also is extremely helpful in clearing hardened blockages more commonly found in older people who suffer heart problems.
The procedure is relatively safe with few complications. Most patients are awake during the procedure and given a local anesthetic. The cardiologist will make a small incision at the top of the thigh or in the wrist and feed a catheter into an artery. An X-ray camera is used to view the catheter. Dye is injected into the artery so the cardiologist can see how large the blockage is and where it is located. A second catheter with a rotablator on the end is inserted into the artery. Once the device is in place, the cardiologist turns on the rotablator and begins to break the plaque off the walls of the artery. Some devices have a pouch to collect the plaque, others have a vacuum, but most often the broken plaque is in small enough pieces that it is just carried away in the blood stream where it is processed and eliminated from the body.
With radial artery access (going through the artery in the wrist) for catheterization, patients can be walking in a few hours with little discomfort, and with their physician’s approval can return to normal activities within days. Pre-treating calcified lesions with rotational atherectomy can be one of the best ways to enhance proper stent placement. Atherectomy is successful in 95 percent of patients.
Rotablation is not for every patient, but serves as a tool in the high-tech treatment options available for those diagnosed with cardiovascular disease. Those with newly opened arteries often feel immediate relief and the vitality that accompanies a heart that is back at work, pumping enough blood to nourish their body. FBN
Dr. Omar Wani, interventional cardiologist, is the medical director of Cardiac Rehabilitation and Noninvasive Cardiology at the Heart & Vascular Center of Northern Arizona (HVCNA). Specializing in interventional cardiac and vascular medicine, Dr. Wani is well respected for his extensive research in cardiovascular medicine, which includes published articles, reference books and presentations.
HVCNA is a cardiovascular physician practice offering services including general cardiology; rhythm abnormalities; the treatment of chronic heart and vascular conditions; and advanced surgical procedures including traditional and minimally invasive open heart surgery. HVCNA cardiovascular specialists include cardiologists, interventional cardiologists, an electrophysiologist, cardiothoracic and vascular surgeons, and specialty trained physician assistants, nurse practitioners and registered nurses. HVCNA is a partnership between Flagstaff Medical Center and Verde Valley Medical Center, with offices located in Flagstaff, Camp Verde, Cottonwood, Sedona and Winslow. For more information, visit NAHeartCare.com. To make an appointment, call 928-773-2150.