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rotablation and its effectiveness in patients with co-morbidities, Health News, ET HealthWorld

By Dr Shuvanan Ray

Coronary Artery Disease (CAD) is caused by plaque buildup in the walls of the arteries that supply blood to the heart and other parts of the body. According to a study published in The Lancet, 2.8 million Indians died from Cardiovascular Disease (CVD) in 2016, out of which 18 per cent of the deaths were due to CAD. One-third of the total CAD cases show a high incidence of coronary artery calcification (CAC). If left unattended, CAD and related clinical conditions like CAC can impose serious problems of blood circulation in the heart.

If there is a significant CAC, the artery walls become solid like a rock and cannot be dilated or opened with balloons for the implantation of stents. Unexpanded stents can pose a huge threat to life due to stent thrombosis and clogging.

Calcium is often a part of the plaque build-up in the arteries. If the calcium breaks off, a blood clot may be formed, blocking the blood flow and oxygen supply to the heart. When a plaque becomes significant, it can end up blocking the blood flow and oxygen supply to the heart. This can damage the heart muscles and can be fatal. Calcium deposits in the arteries form because the muscle cells in the blood vessels start to become hard when they are old or diseased. People with co-morbidities like high blood pressure, high cholesterol, diabetes, or kidney failure are prone to plaque and calcium build-up in the arteries.

What is the procedure of Rotational Atherectomy?

Enables Rotational Atherectomy percutaneous coronary intervention for complex, calcified coronary lesions. It works on the principle of ‘differential cutting’ and preferentially ablates hard inelastic calcified plaque. The use of rotational atherectomy has evolved from plaque debulking to plaque modification to enable balloon angioplasty and optimal stent expansion.

In a normal angioplasty, a balloon is inflated to push aside the plaque and the stent is deployed. However, in a heavily calcified plaque, this simple PCI procedure may not be sufficient. Patients with calcified arteries are advised to have rotational atherectomy or rotablation, a minimally invasive therapeutic technique that uses a small-sized burr to remove the calcific coronary obstruction and ablates the calcium. The burr is rotated at the speed of 150,000 to 200,000 revolutions per minute and cuts the calcium just like how a diamond cuts through the glass. Once the calcium is removed, the stenting is performed with excellent results. Rotational atherectomy is a safe and extensively used technique for the treatment of CAD, saving 90-95% of patients from bypass surgery.

Numerous patients with large calcium deposits in the arteries are referred for bypass surgeries as they are found unfit for stenting procedures. In such cases, modification of the blockage by rotablation proves to be an excellent solution, as by using this treatment route, the stenting in all the arteries can be done with greater success.

After a successful rotational atherectomy and stenting with a drug-eluting stent, the outcome is excellent.

Once the procedure is completed, patients must follow a healthy lifestyle to reduce the risk factors for coronary artery disease. This means eating a healthy diet, discontinuing smoking, weight loss, regular exercise and remaining compliant with medical therapy as advised by the doctor

The information in this article is for educational purposes only and not meant to provide any medical or clinical advice. Please consult your doctor for more information.

Dr Shuvanan Ray, MD, DM(Cardio), FSCAI, FCSI, FACC, Director- Department of Cardiology and Intervention, Fortis Hospitals, Anandapur.

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. shall not be responsible for any damage caused to any person / organization directly or indirectly)

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