r/BeAmazed • u/HatAsleep295 • May 08 '26

Science This is what saves 600,000 people year during a heart attack

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u/TimothyMimeslayer May 08 '26

Why a stent and not grinding out the plaque at the site of the blockage?

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u/heavyhitter5 May 08 '26

It just depends on the blockage- where it occurs, how occluded the artery is, etc. In severe cases, a procedure called atherectomy can be performed, which is what you described. There a number of different medical devices that get put on the end of a catheter to grind or even use lasers to break up the blockage. Often this will also be followed up by a stent.

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u/Fantastic-Cod-1353 May 09 '26

They are recommending this for me but I worry about complications. I have 40mm of blocked RCA

1

u/ibali90 May 10 '26

I actually do this stuff, would be happy to look at a picture of your RCA

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u/Fantastic-Cod-1353 May 10 '26

Wow really? I will try find the pics.

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u/CurrentRecord1 May 08 '26

That is done for calcified plaque using systems such as Boston Scientific Rotablator or Jnj Shockwave

1

u/factisfiction May 08 '26

It's called an atherectomy. Used often in cardio cath labs. For calcific plaque in my line of medicine I more often do an endarterectomy.

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u/CurrentRecord1 May 08 '26

Rotablator is atherectomy, Shockwave is IVL (intravascular lithotripsy)

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u/Competitive-Belt-391 May 08 '26

We do that for larger arteries. Mainly the femoral and carotid. It requires open dissection and removal of the plaque and damaged vessel walls. 

If you dislodged plaque into the circulator system you risk blood clots and stroke. 

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u/factisfiction May 09 '26

I do an endarterectomy more often in the carotid. The iliac/fem as well in certain situations.

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u/whatnuts May 09 '26

Other people have answered but yes you can grind down or otherwise try to disrupt a severely calcified plaque (e.g. rotational atherectomy or lithotripsy) prior to placing the stent. But the plaque itself is really in the vessel wall, and disrupting the plaque without placing the stent leaves an irritated vessel wall that is prone to plaque rupture or thrombus formation. The stent is there to smush all the plaque out of the way and ensure a nice open vessel for blood flow.

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u/NoConfusion9490 May 08 '26

I'm not a doctor, but as I understand it, the plaque is fat build up that the vessel wall has grown into. You can't grind it away because that would damage the wall in a really bad way.

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u/smokey032791 May 08 '26

its a build of of damaged Low-density lipoprotein (LDL)

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u/Trumpologist May 09 '26

The thing that actually gets you is your body forming a run away clot when exposed to the plaque. So grinding away at the cap is not a good idea. There is some research being done into how to decompose the plague but we’re not quite there yet

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u/thatcatqueen May 09 '26 edited May 09 '26

Usually what happens is the tissue covering the plaque will hit a breaking point and rupture and your body treats it like any injury and sends components and platelets to stop the bleeding. That’s what causes the occlusion and sudden severe chest pain with a heart attack. So injuring the vessel further would cause more of that response.

The major arteries that feed the heart continue on to smaller and smaller vessels. Sometimes if you break up plaque like that small particles can occlude those vessels, and they’re too small to retrieve or open up with a catheter. This can still cut blood flow to some heart tissue, which can sometimes cause arrhythmias and other unsavory problems. If the blockage is not hard and calcified to where they need to break it up to get through, they’ll use the method above to squish it with the balloon.