• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.


When skin coronary intercept breaks down and there are complex calcified coronary lesions, Rotational Atherectomy is a technology that helps in a situation like this. It is used to shave off stent struts, it can enable placements and underlying resistant plaque and take appropriate care.  Differential cutting and preferentially ablates hard, inelastic, calcified plaque are the two principles on which this works.

When a blood vessel has plaque deposited, using a catheter which has a sharp blade on one end and which enables to remove plaque from a blood vessel, this procedure is known as Atherectomy. A small puncture is made in the artery, the catheter is inserted into the artery and all of this is done under local anesthesia.

To remove atherosclerotic plaque from diseased arteries, Atherectomy is a procedure which is performed. The devices used in Atherectomy are designed in a different way which take care of these plaques by cutting them, or shaving or vaporizing and therefore have different indications for all of these.

The most troublesome and formidable challenge to the interventional cardiologist is Calcified coronary lesion. Rotational Atherectomy (RA) is safe and efficient as a lesion modifying tool for calcified lesions prior to implantation.

We looked at what is Artherectomy is and how it works, now we can look at this in detail. If there are narrowed coronary arteries Atherectomy is a procedure used to open up those which in turn increases the blood flow. Also, if an artery has hard plaque with a lot of calcium, it be done then as well. When there is surgery happening, when the stent is getting placed in the artery, Atherectomy may make it easier for the doctor while doing that too.

When responses to balloon inflation started becoming uncontrollable and unpredictable and the doctors felt a need to come up with something new, Atherectomy was developed. The angioplasty technique was not appropriate for the vessel to channelize high pressure inflation but it was in fact widening the lumen and this was noticed as a major drawback. Medical Science realised that there was a need to develop a device and hence new devices were introduced

More than 25 years have passed when the first scenario of Rotational Atherectomy was found.  There are no two ways that coronary angiography and angioplasty has taken the world by storm and evolved very well.  Starting off as an alternative to balloon angioplasty, Rotational Atherectomy has now become a conjoint procedure during coronary intervention, especially of excessively calcified or fibrotic lesions.

Why Rotational Atherectomy?

Plaque is removed successfully and that in turn helps in plaque modification. Procedures have become more successful as this allows the delivery of additional devices like stents and balloons. In non-dilatable lesions, where balloon angioplasty leads to incomplete lesion dilation prior to stent deployment, it is the most appropriate course of action.

Risk and side effects:

All surgeries target releasing a person from any kind of discomfort or pain or difficulty but again no surgery comes without risk or any complications and so does Rotational Atherectomy.

Here they are:

  • In Restenosis and MACE, the long-term results have not been very encouraging. This has resulted its usage which was initially 10% of all percutaneous interventions (PCI) coming down to 3-5%.
  • Atherectomy is definitely an evolving technique in calcified coronary artery lesions, but it requires proper evaluation by a thorough professional.
  • There is yet a lot time required to develop this system flawlessly.
  • Temporary heart lung machine ECMO used to provide support to the heart during such interventions. The calcified blockage has to be treated with ROTA angioplasty. ROTA angioplasty requires drilling inside the arteries in order to cut open the calcium. The tip spins at a exemplary speed and grinds away the plaque on the artery walls. In microscopic particles are washed away in the bloodstream of the patient.
  • The patient can face the following reactions:
  • Conduction block
  • Drug and allergic reactions
  • Infections
  • Possibility of a stroke
  • Slow flow or may not flow
  • Vessels trauma
  • Re-blockage of the artery (restenosis). This happens only if the patient is a smoker or is living in a dusty or polluted atmosphere.
  • Other complications associated with this are distortion, kinks and fracture of the guide lines and physical malfunction of the device, which may be lead to patient injury or death.

These are reactions common in adverse situations, Doctors and researchers are still working on it and trying to control bad reactions.  But that simply doesn’t solve the problem, the patient also needs to cooperate and help in letting the doctor do his job so that there is a win – win situation. Therefore, when the patient meets his doctor, it is imperative to ask questions, to make sure he understands the risks of the procedure and why the procedure is recommended.

Finally, all I can say is that we really need a device with all the possibilities, easy to use and easily available in market or with the physician.

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