Plaque, a fatty substance made up of cholesterol, calcium and other materials, builds up in our arteries over time.  An artery blocked by plaque can cause a heart attack, stroke or painful blockages in the blood vessels of the legs.

To reopen the artery for blood flow, an interventional cardiologist can insert a thin tube with a tiny balloon at the end into the artery and open the balloon to push aside the plaque.  This procedure is called angioplasty.

Introduced in the 1980s, angioplasty has become the most common medical intervention in the world.  More than one million angioplasties are performed each year in the U.S. 

But angioplasty only works if the plaque is soft.  In about 12% of cases, calcium accumulations on the artery walls become extremely rigid and hard, too hard for an angioplasty balloon to stretch the artery open. To solve this problem, medical researchers designed the rotablator, a small drill with a burr on the end that is coated in diamond dust.

The rotablator is guided to the blockage via a catheter, a thin, flexible, hollow plastic tube small enough to be threaded through a blood vessel. Air pressure is used to power and rotate the tip at very high speeds against the plaque. When the tip is rotated, it sounds much like the drill a dentist might use. Short bursts of power will rotate the tip up to 190,000 rpm.

The rotablator drills through the calcified plaque, pulverizing the plaque into microscopic pieces as it works. These pieces of plaque are smaller than a red blood cell and will safely travel through the bloodstream and eventually be eliminated. 

This procedure is known as rotational atherectomy. I introduced this procedure to Huguley in 2010, and now it is done routinely in Huguley's cardiac catheterization lab.

Whether the patient receives balloon angioplasty or rotational atherectomy, blood flow to the heart muscle is improved.  In most cases, this will improve symptoms of congestive heart disease, including chest pain and shortness of breath.  In some patients, it reduces the risk of death. 

Research on angioplasty and rotational atherectomy continues to make the procedures safer and more effective, to prevent treated arteries from narrowing again, and to make the procedures an option for more people.

Naginder Sharma, MD, is a board-certified interventional cardiologist at the Huguley office of HeartPlace.  He has extensive training and experience in cardiac catheterization, balloon angioplasty and stenting, techniques of complex coronary intervention, peripheral vascular interventions, sophisticated diagnostic procedures, and many other professional skills. For an appointment, call 817-293-8441.