Rotational Atherectomy is an adjunct to Angioplasty, so to better understand it, we must first learn about Coronary Artery Disease (CAD) and Angioplasty.
CAD is a heart condition in which, over time, fatty deposits, also known as plaque, collect in the artery and obstruct or even block the blood supply to the heart, making the artery hardened and narrowed, causing heart attack symptoms like chest pain.
One of the most common cardiology procedures to treat CAD is Angioplasty. In an angioplasty procedure, a catheter guides a thin wire toward the blocked spot in the artery. This thin wire supports a tiny balloon at its tip which is inflated to open the artery, making room for the removal of plaque. After the plaque is removed and before the balloon is withdrawn, to keep the artery open and avoid restenosis (re-narrowing of the artery), a metal stent is often implanted.
But not every time the procedure is this straightforward and easy to perform. In some cases, when the plaque build-up remains in the artery for too long, it turns into hardened calcified plaque, which the balloon can’t get through. It is precisely then that Rotational Atherectomy is used as an adjunct to the Angioplasty procedure.
What is Rotational Atherectomy
Rotational Atherectomy, also known as Rotablation, is a technique specifically designed to modify calcified plaque. In the procedure, a special catheter is used to guide a thin wire, with a tiny drill at its tip, to the narrowed or blocked spot. The drill uses a high-speed rotating burr that effectively scrapes, smoothens and removes the unyielding calcium deposits from the artery and makes space for the Angioplasty procedure.
How Rotational Atherectomy Works
Procedure Steps:
- A guidewire, with the help of a catheter, is inserted into the affected coronary artery to guide the procedure.
- With the guidewire, the Rotablation device is directed toward the narrowed spot.
- The Rotablation burr rotates at high speeds and grinds away the Calcium deposits, enlarging the arterial lumen.
- After the calcified plaque is removed, the physician evaluates the vessel’s size and condition.
- After successful Rotablation procedure, Balloon Angioplasty and stent placement can then be performed effectively.
Rotational Atherectomy is highly effective in modifying the hardened, heavily calcified plaque, enabling better stent deployment and improved long-term outcomes of Angioplasty.
Suitable Stent Implant with Rotational Atherectomy
It is reported that bare metal stents have a higher chance of restenosis (scar tissue build-up and re-narrowing of the artery) so drug-eluting stents are considered to be a safer option after a Rotational Atherectomy procedure.
What is a Stent?
A heart artery stent is a small mesh tube inserted into a blocked or narrow artery to help keep it open and improve blood flow to the heart. This procedure, known as coronary stenting, is a standard treatment for coronary artery disease, a leading cause of heart attacks in India. Suppose anyone in your family is diagnosed with coronary artery disease. In that case, it is essential to understand the types of stents available in India and choose the available stents for your needs. Here, we will explore the different types of stents available in India and help you make an informed decision.
Types of Stents in Cardiology
Types of Stents: Three main types of coronary stents are available in India: Bare-Metal, Bio-Absorbable Polymer, & Drug Eluting Stents. These are the standard types of stents for Angioplasty used during different types of Percutaneous Coronary Intervention procedures. Together, these represent the most widely used types of cardiac stents globally.
Bare-Metal Stents
Bare-Metal Stents are made of metal and do not have a special coating. They are inserted into the artery to keep it open, but they can also stimulate the growth of scar tissue that causes the artery to narrow again.
Drug-Eluting Stents
Drug-eluting stents help prevent the growth of scar tissue as they are coated with an essential medication to perform the task. This type of stent is often recommended for patients at high risk of restenosis (the re-narrowing of the artery). The medication is slowly released over time, helping to keep the artery open and reducing the risk of restenosis.
Bio-Absorbable Polymer Stents
Also known as biodegradable or biodegradable polymer stents, these are medical devices used in interventional cardiology and other medical fields to treat narrowed or blocked blood vessels. Stents are typically used to support and maintain the patency (openness) of these vessels. Unlike traditional metallic stents, which are designed to remain in the body permanently, bioabsorbable polymer stents are designed to degrade and be absorbed by the body over time.
Benefits Of Stenting:
- Stents are effective in restoring the blood flow
- A stent implant improves the symptoms of a heart attack, including angina.
- Stents minimise the chances of restenosis
Risks of Stenting:
Although stents are lifesaving, the risks of stenting can’t be avoided, especially if the patient has pre-existing medical conditions or comorbidities, including diabetes and hypertension.
- Stents sometimes trigger allergic reactions to their metal content or the drug the stent is coated with
- A stent sometimes gets scar tissue built up around it, which becomes the primary cause of restenosis
It is to note that for CAD, a stent is not always the preferred option to restore the blood flow to the heart. In some cases, Balloon Angioplasty alone proves to be enough. Understanding Angioplasty and Rotational Atherectomy is crucial in minimising doubt and making informed medical decisions.
CONCLUSION:
It is advised to cover all aspects of heart health, be it making heart-healthy lifestyle choices, getting regular checks done, understanding Angioplasty, Rotational Atherectomy and types of stents in cardiology. Doubt and ignorance are the worst enemies of the heart, so consult your cardiologist to find out absolutely everything about your heart health, and follow their lead.
