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First introduced in 1993, a rotablator is a miniature drill capped with an abrasive, diamond-studded burr. The rotablator is used in a type of catheter-based procedure called rotational atherectomy.
Rotational atherectomy is a minimally invasive treatment that is sometimes used to pulverize hardened plaque within a coronary artery. During rotational atherectomy, 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.
Once the rotablator is in position, the physician activates the burr. Spinning between 140,000 and 200,000 times a minute, the diamond-chipped burr grinds the plaque into microparticles, which then travel harmlessly through the circulatory system and are eventually eliminated by the body. During rotablator procedures, it is routine to use a temporary pacemaker, because the microparticles may slow the heart rate.
A rotational atherectomy is just one type of coronary atherectomy. The other two types are as follows:
- In directional coronary atherectomy, the catheter tip is equipped with a bladed device that cuts away the plaque and stores the little pieces in a tiny container. The plaque is then removed when the catheter is withdrawn from the artery.
- A transluminal extraction uses special catheters with small rotating blades and a hollow tube. As plaque is cut away from the artery wall, it is sucked into the tube through a vacuum and expelled from the body.
Rotational atherectomy may be performed either instead of, or in addition to, the more traditional balloon angioplasty when plaque has become exceptionally hard (due to calcification) or presents other challenges. Most commonly, rotational atherectomy is performed in the case of severely calcified plaque deposits. In this case, it will frequently be followed by balloon angioplasty to obtain better results. Studies have shown that, for certain lesions, the combination of rotational atherectomy and angioplasty reduces the rate of re-narrowing (restenose) of the cleared artery. This may be especially true of patients over 70, who are likely to have a greater degree of arterial calcification.
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Rotational atherectomy may also be used prior to placement of a stent, although data are mixed about its effectiveness. Improvements in angioplasty and stent technology, which are reducing restenosis, may make rotational atherectomy less necessary.
Patients who have poorly functioning left ventricles, or who have already had coronary bypass surgery, may not be suitable candidates for rotational atherectomy. In addition, rotational atherectomy carries certain risks, including:
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Coronary artery spasm, dissection or perforation.
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Microembolization, or the effect of thousands of tiny pieces of calcified plaque showering through the bloodstream. | 
