Rotablation, or rotational atherectomy, is a technique used in interventional cardiology to modify coronary plaques that are so heavily calcified that standard balloon inflation cannot adequately expand them. Understanding why this matters requires understanding what calcification does to a coronary plaque. In a heavily calcified lesion, the plaque contains deposits of calcium that give the arterial wall the consistency of eggshell rather than the pliable tissue of a normal artery. When a standard angioplasty balloon is inflated inside such a vessel, the calcium does not yield: the balloon either inflates in the softer non-calcified segments of the plaque, creating an uneven expansion, or cannot be inflated to the pressure required for full expansion at all. The result is an incompletely expanded stent, which sits unevenly in the vessel, is at higher risk of stent thrombosis and restenosis, and does not perform with the effectiveness that a properly expanded drug-eluting stent delivers. Rotablation solves this problem by modifying the calcium before the balloon and stent are delivered. A rotablation system uses a diamond-tipped burr mounted on a drive shaft, spinning at up to 200,000 revolutions per minute, that is advanced over the coronary guidewire to the calcified lesion and passed through it. The diamond-tipped burr ablates the calcium, converting the rigid calcified plaque into a surface that can be adequately dilated by a balloon and fully expanded by a stent. It does not remove all the plaque, but it modifies the calcium structure sufficiently to allow the stent to expand to its full intended diameter and embed evenly in the vessel wall. The clinical significance of this is that many patients who have been told their coronary disease is too calcified to be treated by stenting, and who have therefore been excluded from less invasive treatment, can in fact be treated by PCI with rotablation, restoring blood flow without the need for bypass surgery. At Hridhay Heart Center, Gajuwaka, Visakhapatnam, rotablation is available as part of the complex coronary intervention programme, and patients referred from across Andhra Pradesh with apparently untreatable calcified coronary disease have been successfully treated here without needing to travel to a metropolitan centre.
Related reading:
Coronary Artery Disease: A Complete Patient Guide from Diagnosis to Recovery
Breaking Down Complex Coronary Blockages: When and Why Advanced Interventions Matter
Diabetes and Heart Disease: Why Indians With Type 2 Diabetes Are at Higher Coronary Risk
The Critical Role of Preventive Cardiology: Building a Heart-Healthy Future
Written by Dr. K Narayana Raju, MBBS, MD, DNB Cardiology (Narayana Hrudayalaya, Bengaluru), Consultant Interventional Cardiologist, Hridhay Heart Center, Gajuwaka, Visakhapatnam 530026. Phone: +91 85999 56999.
