What is rotablation?

What is rotablation?

Rotablation is a special procedure in which a tiny diamond burr rotating at high speed is used to remove difficult to remove blocks from blood vessels of the heart. The diamond burr is attached to the end of a thin long device introduced through the blood vessel of the groin. The physical principle of rotablation is differential cutting. The advancing rotablator burr selectively cuts inelastic material while elastic material deflects away from the burr. As 95% of the particles generated by rotablation are less than 5 microns in diameter, they are removed from the body by the body’s own scavenging system known as reticuloendothelial system.

Rotablation facilitates angioplasty of severe blocks in blood vessels of the heart with a lot of calcium deposits, which are usually difficult to remove by balloon angioplasty. In balloon angioplasty, sturdy balloons attached to long thin tubes known as balloon catheters introduced through blood vessels of wrist or groin are used to remove blocks in blood vessels. In balloon angioplasty, block is removed by inflating the balloon across the block, using a syringe like mechanism, to tear off and displace the fatty material producing the block. But this will not work if there is a lot of calcium deposits in the blocks, which makes them hard to remove by usual balloon angioplasty.

Diamond burr has a usual rotational speed of 140,000 to 150,000 revolutions per minute. Rotablator burr sizes range from 1.25-2.5 mm and burr speeds range from 140,000-190,000 rpm. Compressed air or nitrogen is used to spin the drive shaft and the burr. It is pumped through a pneumatic hose into the advancer to rotate the turbine housed within it.  Rotablation is done in short runs of 15 to 20 seconds each time. Medications to prevent clot formation and to enlarge the blood vessel temporarily are given during the procedure. Flush solutions are used to flush out the tiny particles produced by cutting. Other emergency medical support devices are at hand to be used in case of need. The procedure is done in the cardiac catheterization laboratory, under continuous X-ray imaging, like coronary balloon angioplasty.

Special techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) may be used to guide rotational atherectomy. Intravascular ultrasound is ultrasound imaging of blood vessels using tiny devices introduced inside the blood vessels. Optical coherence tomography uses near infra-red light for imaging inside the blood vessels. Both tests need advanced and expensive equipment made specially for the purpose. The devices are attached to thin tube like structures and are introduced through blood vessels of wrist or groin under continuous X-ray imaging.