Percutaneous Transluminal Coronary Rotational Ablation (PTCRA)

Percutaneous Transluminal Coronary Rotational Ablation (PTCRA) is a procedure to attempt to open up a blocked coronary artery by drilling through the narrowing. The catheter used for this intervention has a tiny football-shaped tip which spins rapidly and ablates, or grinds up, the blockage. Because of its special design, the catheter tip only grinds up blockages. The walls of the artery are pushed out of the way and are not hurt by the drilling.

The decision to use PTCRA instead of angioplasty alone or atherectomy is based on the location and shape of the blockage, the size and shape of the coronary artery, and whether clots are present in the artery. All of these considerations are up to the discretion of your doctor.

When it is determined that PTCRA is appropriate, a long thin guidewire is passed from your femoral artery up through the blockage in your coronary artery. The doctor then threads the correct-sized PTCRA catheter onto the guidewire, positioning it near the blockage. The tips of the PTCRA catheters come in different sizes to match the size of your coronary artery. Once the procedure begins, you will hear a high-pitched sound whenever the catheter tip spins. The doctor will advance the spinning catheter through the blockage. The particles produced by the drilling are typically smaller than your normal red blood cells and are washed away into your bloodstream. These tiny particles dissipate and will not cause any ill effects.

You may feel some chest pain when the catheter is drilling through the blockage, because the tip temporarily blocks blood flow to a portion of your heart muscle. If you feel discomfort during the procedure, tell the doctor. The catheter tip will be passed through the blockage several times, grinding up as much of the blockage as possible. Balloon catheters are then inserted onto the guidewire and used to smooth out the wall of the coronary artery.

At the end of the procedure, repeat angiography is taken to determine if the artery is completely open. You will then be taken to your hospital room where you will recover until discharge.