Drilling the plaque from your arteries? Is this true??

[Rob6868]

Hi everyone

Hope you all had a great Christmas and are as healthy as can be.

Just a quick story.

Bumped into a long lost work colleague in the sainsbury isle of all places boxing day.

Had a chat and he suddenly says oh I've been in hospital with AF .

Oh so have I and I've had a stent.

So we get chatting about our hearts..like you do in a sainsbury isle 😂😂😁

He suddenly says they put a stent in to open up the arteries then used a drill thing...he's words lol to take all the plague out that was really bad and around he's heart. .

Now I've seen something about this on the Internet.

Is it true? And if so then why are we all not having the plaque removed with this device? He also suffers from COPD amongst other things by the sound of it.

But off he went chuckling away and to the pub...and still smokes...great while I try to convince him he could do with stopping all that .

So that's the question.

The Drill thing as he put it that removes all the plaque

[Chappychap]

No, it's not true. There is no drill.

It's a common misconception that plaque builds up on the inside surfaces of the arteries. It doesn't, plaque actually builds up within the arterial walls themselves. Any mechanical device such as a "drill" would have to destroy the innermost layer of the arteries (the intima or endothelium) in order to get to the plaque. That's not a great idea as it would trigger massive thrombosis which would almost certainly prove fatal!

[Milkfairy Heart Star in reply to Chappychap]

Actually you'd be surprised what Cardiologists get upto....

nhs.uk/conditions/coronary-...

Percutaneous transluminal coronary rotational atherectomy (PTCRA) – where a small rotating device is used to remove the fatty deposit

Percutaneous laser coronary angioplasty– where a laser is used to burn through the fatty deposit

cochrane.org/CD003334/VASC_...

Happy New Year!

[Chappychap in reply to Milkfairy]

Good point, but my understanding is that these are specialist procedures for tiny sections of an artery, where as the discussion reported in the original post suggested this "drill" was used extensively to remove "all the plaque". As far as I'm aware that's simply not possible.

[Milkfairy Heart Star in reply to Chappychap]

Well a lot gets lost in 'translation and interpretation .'

We were not there when the procedure was explained by the clinician to the person.

I have taken my husband to some of my consultations and he usually hears something completely different to me! That's why he is there , 2 pairs of ears are better than one.

[Rob6868 in reply to Milkfairy]

Your right milkfairy

Alot was lost in translation but between myself and my friend..

I knew exactly what he meant but I don't think he knew what the device was lol.

But! My question is why is it that this is not standard procedure if it clears the plaque completely? Surely that can only be a good thing?

My friend said the cardiologist funnily enough he's the same cardiologist I was MEANT to have but got someone different in the end...sorry my friend said he implanted a sent first then went through the sent with this small machine to remove the plaque so he could deal with the AF.

So in a nutshell why wasn't I or anyone else offered this instead of a good old stent

[MichaelJH Heart Star]

This procedure using a device called a rotablator that is designed to breakdown the plaque into microscopic particles without damaging artery walls where calcification prevents angioplasty and stent insertion. It is only applicable in some circumstances - where not it is bypass territory as it was in my view.

A former neighbour has/had your friend's attitude. Before he moved he had been back twice for further stents. A colleague's father is forty years post bypass and still doing well in his nineties but then he plays by the rules!

[Chappychap in reply to MichaelJH]

I stand corrected Michael and I've learnt something there. I've read several references to "rotoblator" in US procedures but had assumed it was a crude analogy with an agricultural implement!

My bad, and thanks to you and Milkfairy for putting me right.

[shopman in reply to Chappychap]

If you want an explanation of Rotablation then this can be a good read herzzentrum.immanuel.de/en/...

Initially back in October 2017 I was considered for this as although having had an initial 4xCABG 20 years ago and several stents in recent times I do have 1 graft that is totally blocked and unable to be stented. The suggestion was to undergo Rotablation to my original arteries but that has since been put on the back burner due to other considerations.

[Rob6868 in reply to shopman]

Thank you shopman

So my question still is.

Why is it only certain people have this procedure? Especially if it can actually take the plaque away..for good it seems.

[shopman in reply to Rob6868]

If you were to have the meeting where it is discussed with you it may make you think.

Firstly there is the noise, supposedly it is akin to the noise made by the dentists drill. It is air operated and rotates at something like 140000rpm. It is not without its dangers - mainly a slip with the drill and it goes through your artery wall & considering where it is then there is the possibility of a further HA, stroke or worse. Also bits of calcification could be dislodged and cause further clots etc. I was also told there can be a burning smell as it does have to exhaust itself.

Taken in context though, the people operating these procedures are much more skilled than the guy with the windypick repairing potholes in the road. I agreed to have it as for me the benefits far outweigh the risks. I wouldn't think it is performed everywhere and may be restricted to the more specialised Cardiac centres - I have had all my procedures at the Freeman in Newcastle.

[Dovaston]

I had Rotoblation for my first Angioplasty so can confirm this is done in the UK

[Rob6868 in reply to Dovaston]

Thank you for your reply! So my question to you us.

Why was it that you were able to have this procedure but it's not common practice? Was there a specific reason?

Because I'm thinking why can't we all have this done? Surely it then means your clear from plaque?

[Dovaston in reply to Rob6868]

Hi this was not a pre-planned procedure. I had a 98% blockage in LAD .Whilst trying to stent that part of the artery it was discovered the stent would not expand due to hardened plaque. In view of this a ' cutter' was used to be able to allow stenting. So procedure was only for small part of artery shame it wasn't done for all of them !

[Kristin1812 Heart Star]

I’ve had one done, too. My understanding was not that it ‘cleared the plaque’, but that it could drill a big enough channel to get a stent in.

[shopman in reply to Kristin1812]

Spot on.

[isobelhannah18]

Thank-you Milkfairy and shopman for the interesting and informative links.

[KEN65]

Very interesting comments and being one with 6 stents I did wonder why this was not a procedure for me, hopefully future generations will have this type of treatment, good discussion.

[Love100cats]

Your post brought back some memories. When my husband had his first heart attack 30 years ago there were fewer options. For a week it was touch and go. About a year later Oxford hospital thought they would try the clearing of his arteries with little brushes but after checking with the balloons decided he was too fragile and left them alone. He continued on meds alone but 20 years or so later had multiple stents put in which saved his life at that point. He is still going though he has a pacemaker and defibrillator. Some proccedures are too risky for some. They have to weigh up the consequences. I hope this helps.

[Prada47]

Hi Rob

I have a total occlusion in my RCA, during By pass surgery they decided to leave it alone as it was deemed non viable. After surgery almost 3 years later I had no improvement to breathing or left arm pain whilst walking ( angina ) so a different Cardiologist did an angiogram and came back with your LAD which was by passed didn't actually by pass your blockage, so he said stents through the by pass to clear my Proximal LAD which has proved to be a partial success !!

Now back to my RCA he says he can clear it with a Rotablator But it would be Difficult and Risky, entry would be through Groin and Wrist at the same time with Himself and another Cardiologist working in tandem. So for the reward I didn't think it was worth the risk, But again a But he would try if I requested. I will see him again in February after an Echo scan to see how it's all going but at 72 this year I don't feel the Risk is worth the reward. So onward and upward with the Isosorbide, Beta Blocker, Eplerenone, Clopidogerel, Furosemide, Omneprazole, and the good ole Statin.

[Prada47 in reply to Prada47]

Oh and the Candesartan of course

[Phil-52]

I've looked long and hard at all sorts of revolutionary ideas but nothing seems to develop into actual treatments. I doubt that I would have been sliced open and bits of me re-arranged if there was an alternative. I am looking forward to the day when they develop a pill to reverse the arterial blockages however as with four extra grafts I will become Superman Happy new year all and keep taking the tablets.

[redcarpet123]

My brother had a heart attack and drinks loads and also smokes. I think he's a fool but try telling him he will say I've got a life. You can't understand this. I've been told by my cardiologist live your life but I know I can have 14units if drink per week but I won't go over that. I haven't smoked since 1974/5 it was hard at first but smoking doesn't interest me.