Yes we do use devices occasionally to remove/shave/excise plaques but this is used in less than 5% of coronary angioplasties at present.
The current devices licensed for plaque removal usage in the heart are called:
- Rotablator (a nickel plated brass burr with microscopic diamond crystals on it rotating at high speed) which excises the hard plaque tissue
- Excimer laser (which uses high energy light to dissolve plaque without harming healthy tissue) and
- Orbital atherectomy (which uses a diamond coated crown rotating at high speed to kind of “sand ” the calcium away).
As highly calcified vessels are seen in about 8-10% of all angioplasties I would think the use of these devices will increase in future.
However due to cost, need for time to setup the device and higher complications in inexperienced hands, these devices are not always used.
In the majority of cases when a stent is deployed with a balloon the fat is literally “squeezed” between the outer wall of the blood vessel and the stent and over time is gradually resorbed while the inner lumen is kept enlarged by the stent scaffold which is covered by the inner layer of the blood vessel over 3 to 6 months.
