Grinding Wheel Motion and Force During Plaque Removal by Rotational Atherectomy in Angulated Coronary Artery

Rotational atherectomy (RA) utilizes a high-speed diamond grinding wheel to remove the calcified atherosclerotic plaque off the vessel wall via a catheter inside an artery for blood flow restoration and treatment of cardiovascular diseases. RA in angulated lesions is challenging due to the geometric constrains on the wheel motion, potentially leading to vessel dissection and perforation. To understand the grinding wheel motion and force during RA in curved arteries, experiments were conducted based on 3D printed anatomically accurate coronary artery phantoms with plaster coating as the plaque surrogate, a high-speed camera, and a multi-axis force transducer. Results showed that the grinding wheel did not orbit inside right coronary artery phantom which led to a highly biased ground region aligned with several contact points between the guidewire and the arterial wall. The grinding wheel orbital motion facilitated an even treatment of several segments in left anterior descending coronary artery phantom. The grinding force, ranging from 0.05 to 0.20 N, increased with the wheel rotational speed when the wheel orbited and was insensitive to the wheel speed without wheel orbital motion. This study explained the clinically observed guidewire bias from the engineering perspective and further revealed the RA mechanism of action in angulated artery, which may assist to improve the device design and the operating technique.