How Do Cardiologists unblock a Narrowing Containing Calcium | Atherectomy

In some individuals, blockages in the wall of the heart arteries can develop calcium, a very strong material that forms our bones and teeth. When there is significant calcium causing a blockage, simple measures to unblock the artery using only balloons may fail. In these situations, your Cardiologist may choose to try to use a special device that goes within the artery and acts like a superfast drill that spins and breaks up the calcium layers and then allow passage of a stent to keep the artery open. Professor Barlis discusses this technique in this video and how it may be helpful.

[@tejanochris]

I am having this done this coming week. I am older and explained to my doctor that I couldnt see a balloon being used over the blockage. Makes no sense. Just stretches out the wall even more. A stent would do about the same. So he will be doing Atherectomy. The first doctor I went to didnt believe in it so I walked out and was fortunate to find a doctor that does.

[@stellasinanan4116]

Your videos and explanations are amazing and informative I have recently done angioplasty and you have helped me understand so much of the process and my condition. I thank you for your information and the way you make it so easy to understand . Keep up the excellent work you and your team are doing

[@jerseytony1]

Professor Barlis Is the most honest professional smartest cardiologist in the whole world. He doesn't try to scare people to become his patients like all other drs do. He just gives the facts and options may he live at least forever!

[@leolammas7940]

excellent explanation of an angiogram procedure.

[@Mary-vu6td]

Thanks ❤️

[@n2daair23]

Is placement of a stent always necessary after this procedure?

[@rms2991]

Assuming there is a 80% blockage, via calcium, when drilling, what happens to blood flow within that artery? Whether a stent, or drilling then stent, is not the downstream heart muscle starved of oxygen? Thank you.

[@nomorenews]

Can the procedure burst the artery?

[@albertyuen1527]

Do u need to suck up the small prices of calcium after or during the drill? Else the small fracking may cause a stroke?
Great video. I am watch them.

[@HeartMatters]

Thank you Albert!

[@SolarAB]

Hello, Albert. In general, the complication which could result from embolization during a coronary angiography would be obturation of the artery being worked on, but distal to the stenosed segment. That would cause the part of the heart muscle that is normally supplied by the (now occluded) artery to become ischemic, and if blood flow isn't restored in a timely manner, heart muscle would start to progressively die (infarction).
As for the drilling procedure (rotablation), there are two types of precautions taken to help prevent embolization. First, there is active aspiration during the drilling of the calcium, "sucking up" the debris. Second, the rotablator (drill bit) is designed to grind the calcium down to particles with a diameter of less than 5 micrometers (smaller than a single red cell), so that the debris can freely circulate in the bloodstream, even through tiny capilaries, until it gets absorbed.

[@TheBassfresh]

where do the particles go?

[@TomM-iw3te]

Once the calcium is drilled out what happens to the calcium particles and can the tear the arterial wall as they free float around the heart and overall body??

[@HeartMatters]

Excellent question!! I will bring this up during an upcoming Q&A. Essentially the particles are so small, they eventually get broken up and absorbed within the body, some can get trapped within the heart muscle and that is often the reason there is raised blood levels of troponin after angioplasty and stent procedures. Great suggestion!

[@markplaton84]

That looks like it clean's them out pretty well why use a stent after?

[@HeartMatters]

Good question Mark, as the device drills inside the calcium, it often causes tiny fractures and disrupts the plaque and calcium making this a high risk scenario for the artery to quickly close down again if a stent isnt placed. The stent essentially acts like a scaffold to keep the artery open, expecially when there is calcium there, an often very hard material.

[@NomadBroncoFan]

I thought calcified plaque builds up behind the endothelium. How can a drill be used without destroying the endothelium? Confused.

[@bscsmscs1578]

calcium is a part of clot factors for stabalization of clot/inflammation. Even if endothelium is destroyed in the diseased portion, mesh installed is permanetly embeded and a new endothelium will grow over this mesh