Rotational Atherectomy
A coronary artery's calcium deposits are a sign of prior inflammation, healing, and scarring. Considerable atherosclerotic coronary artery disease (CAD) is correlated with significant calcification. Coronary calcification can be diffusely distributed throughout coronary arteries, and when the vessel is imaged, considerable calcification can completely encircle it. When using standard balloon angioplasty, coronary stenosis with circumferential or substantial vascular calcification is stiff and generally can't be dilated. In severely calcified coronary lesions, stent dilatation and maximum vessel wall apposition are frequently compromised. Stents placed in severely calcified vessels without atherectomy often thrombose, produce restenosis, and even fracture. Balloon angioplasty still has significant calcification as a major drawback, as does successfully delivering stents to severely damaged arteries. High-pressure, non-compliant balloon inflations may still fail to sufficiently dilate and prepare a substantially calcified artery for stent delivery in situations with heavily calcified lesions.
In this example, calcium is the blocking material, and atherectomy refers to its removal. The vessel wall compliance in calcified or fibrotic lesions is increased by removing significant calcification or changing the calcified atherosclerotic plaque, and the lumen diameter obtained from using this device will be significantly better than that obtained from using straightforward balloon angioplasty. One of the several techniques for doing an atherectomy in a coronary vessel is rotational atherectomy. It is the most popular atherectomy tool and eliminates atheromatous plaque via differential cutting, which involves removing the inelastic calcified plaque with microscopic diamond chips implanted on the surface of a fast-revolving olive-shaped burr (150,000 to 200,000 rpm). The reticuloendothelial system removes the 2 to 5-micrometer microparticles that are produced as a result of this abrasion after they have traveled through the coronary microcirculation. The burr has a diameter of 1.25 to 2.50 mm and travels on a specialized guidewire. Smaller burr sizes should be used initially in cases with severe calcification, followed by bigger burrs in 0.25 to 0.50-mm increments up to 70% of the reference vessel diameter. In the early 1980s, David Auth began looking into the potential of employing a rotary tool to debulk atherosclerotic plaque. In 1988, Fourier et al. performed the first RA procedure on a human coronary artery.