Rotational atherectomy

What is rotational atherectomy?

Rotational atherectomy is a type of surgical procedure that aims to unblock arteries which have become clogged up with plaque. It is carried out by an interventional cardiologist.

Who would need the procedure?

Rotational atherectomy is sometimes offered to patients with coronary heart disease. Coronary heart disease is a condition where the blood flow around the heart is hampered by the build-up of plaque in the arteries, carrying a risk of complete blockage. A complete blockage can in turn lead to heart attack or stroke.

There are a number of ways to unblock the arteries. One procedure commonly performed is balloon angioplasty, where the affected artery is widened (dilated) with a small balloon and held in place with the use of stents, restoring normal blood flow.

However, there are a number of situations where rotational atherectomy might be a better option:

• In older patients, the arteries are much harder and not always flexible enough to be dilated with stents right away. A rotational atherectomy can clear away some of the plaque and detach it from the artery wall to make stenting possible.
• Some parts of the artery may be too difficult to reach with the instruments used in angioplasty, but are treatable with rotational atherectomy.
• Some arteries may resist stents and simply become narrow again. Rotational atherectomy can be used to shave off the original stents and prepare the area for better stenting the second time round.

Rotational atherectomy is not recommended if your left ventricle is weak.

How does it work?

Rotational atherectomy is a minimally-invasive procedure, involving just a small incision made near the groin. The procedure can generally be performed under local anaesthetic.

The surgeon will introduce a thin, flexible tube into the affected artery, before feeding the atherectomy wire through the catheter. The atherectomy wire is extremely thin – less than 1mm wide – with a small rotating head known as a burr. The burr can come in different sizes, depending on the size of the artery being operated on.

The surgeon brings the burr to the blockage and gently treats the built-up plaque. When the plaque has been smoothed out, the surgeon is likely to complete the procedure with a balloon angioplasty to dilate the artery, and the placement of a stent to keep it held open.

What happens afterwards?

Because the procedure carries small risks of bleeding round the heart or tearing of the artery, most patients will stay in hospital overnight after the procedure in case there are any complications the surgeon needs to see to.

In terms of recovery, it is likely patients will be advised to avoid strenuous exercise for the next few weeks, and they may need blood-thinning medication in the long term.