Name of the Procedure:

Catheter, Transluminal Atherectomy, Rotational (C1724)

• Common Names: Rotational Atherectomy, Rotablator Procedure
• Technical/Medical Terms: Percutaneous Coronary Intervention (PCI) with Rotational Atherectomy

Summary

The rotational atherectomy procedure involves using a specialized catheter with a rotational device to remove atherosclerotic plaque buildup from the arteries. It is primarily used in coronary arteries but can be applied to other arteries as well.

Purpose

The primary goal of rotational atherectomy is to open up narrowed or blocked arteries and improve blood flow. This procedure can alleviate symptoms like chest pain (angina) and prevent future heart attacks. It is particularly useful when other methods, such as balloon angioplasty, are insufficient or unsuitable.

Indications

• Severe atherosclerotic plaque buildup
• Calcified coronary artery disease
• Symptomatic angina not relieved by medication
• High-risk patients where other interventions have failed

Preparation

• Fasting for 6-8 hours prior to the procedure
• Adjustment or temporary cessation of certain medications (e.g., blood thinners)
• Pre-procedure tests: Blood tests, ECG, echocardiogram, and imaging studies like coronary angiography

Procedure Description

1. Anesthesia: Local anesthesia with possible sedation is administered.
2. Access: A small incision is made, usually in the groin or wrist, to access the femoral or radial artery.
3. Catheter Insertion: A guiding catheter is inserted and navigated to the affected artery.
4. Rotational Device: A rotational atherectomy device with a diamond-coated burr is advanced to the lesion site.
5. Plaque Removal: The device is activated and rotates at high speed to grind away the plaque.
6. Balloon Angioplasty/Stenting: Often followed by balloon angioplasty or stent placement to keep the artery open.
7. Completion: The device and catheters are removed, and the incision site is closed.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity.

Setting

Rotational atherectomy is usually performed in a hospital's cardiac catheterization lab.

Personnel

• Interventional Cardiologist
• Cardiac Nurses
• Radiology Technicians
• Anesthesiologist (if deeper sedation is required)

Risks and Complications

• Common: Bleeding at the catheter insertion site, temporary discomfort, arrhythmias
• Rare: Arterial rupture, heart attack, stroke, severe allergic reactions to contrast dye

Benefits

• Immediate relief from chest pain (angina)
• Improved blood flow and cardiac function
• Reduced risk of future heart attacks
• Enhanced quality of life

Recovery

• Monitoring in a recovery area or hospital room for several hours
• Instructions on activity restrictions (e.g., avoid heavy lifting for a few days)
• Medications to prevent blood clots
• Follow-up appointments to monitor recovery and the effectiveness of the intervention

Alternatives

• Medical therapy alone (e.g., medications)
• Balloon angioplasty without rotational atherectomy
• Coronary artery bypass grafting (CABG) surgery
• Lifestyle modifications (e.g., diet, exercise)

Pros and Cons:

• Rotational Atherectomy: Highly effective for calcified plaques, immediate symptom relief, minimally invasive
• Alternatives: Varying levels of invasiveness, recovery times, and effectiveness depending on the patient's specific condition

Patient Experience

Patients might feel some pressure or mild discomfort during the procedure, but pain is generally well-managed with local anesthesia and sedation. Post-procedure, there might be site tenderness and minor bruising. Most patients can resume normal activities within a few days, although full recovery may take up to a week. Pain management includes over-the-counter pain relievers and comfort measures as needed.