What is rotational atherectomy?
Why would a doctor recommend rotational atherectomy?
What does a rotational atherectomy involve?
How long is the recovery after a rotational atherectomy?
What is rotational atherectomy?
Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or from the heart. Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing. Rotational atherectomy is done at Dartmouth-Hitchcock Medical Center's Catheterization Lab.
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Why would a doctor recommend rotational atherectomy?
As you age, your arteries can become clogged from a buildup of fats, cholesterol, and other substances, reducing your heart's ability to deliver blood. This narrowing of the arteries, or arteriosclerosis, can cause many heart problems, including:
Rotational atherectomy can open an artery that isn't clogged beyond repair. In general, rotational atherectomy is used to "debulk" a narrowing before using other techniques such as balloon angioplasty and stent placement.
It is also used to treat narrowing in the arteries that supply the kidneys and the brain, and the arteries that carry blood to the far reaches of your body—your arm and leg muscles, and the organs in and below your stomach area.
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What does rotational atherectomy involve?
With the patient awake and under local pain medicine, the doctor inserts a thin, flexible tube (catheter) in an artery, usually near the patient's groin. Using an X-ray camera, the doctor guides the catheter to the site of the narrowed artery.
The doctor then injects a harmless dye into the artery, and takes an angiogram, or picture of the artery. This helps the doctor see the exact size and place of the blockage.
Using a guidewire, the doctor threads another catheter to the site of the blockage. This catheter has a small, rotating, diamond-tipped burr at its tip, which grinds away the arterial plaque. The plaque then moves through the circulatory system and out of the body.
In many cases, the doctor places a narrow metal tube, or stent, inside the artery to keep it from closing. Newer drug-eluting stents slowly release medication that help keep the blood vessel from reclosing. At times, a doctor will use a distal protection device—a kind of filter—to block loosened fatty deposits from entering the bloodstream.
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How long is the recovery after a rotational atherectomy?
Patients often can walk within six hours after the procedure. Most patients spend the night in the hospital, return home within a day or two, and go back to work within a few days.
Patients with stents should not do strong exercise for 30 days. They will also take blood-thinning medication the rest of their lives.
In about 40 percent of patients (20 percent of those with stents), the opened artery narrows again within six months after the procedure. These patients may need another angioplasty, or coronary artery bypass surgery.
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