February 6, 1994
by Mary Powers
Jimmy Rogers's heart was so starved for blood the 51-year-old West Tennessee truck driver couldn't walk 400 yards without sitting down to catch his breath.
In January, doctors identified the problem -- his heart's main blood vessel was dangerously narrowed by fatty deposits. But unclogging it wasn't going to be easy.
Earlier treatment had left Roger's chest wall so damaged doctors feared it wouldn't heal if they tried heart bypass surgery. The narrowing was located in a section of artery that disqualified other options, including balloon angioplasty.
So on Jan. 11, Rogers became one of the first local patients to have his arteries cleaned with a diamond-tipped drill spinning at nearly 200,000 revolutions per minute. The drill reduced the artery-clogging deposits to molecules generally smaller than red blood cells. The molecules could then be disposed of just like old red blood cells could.
"I was wide awake. I got to watch it on TV. I couldn't believe it was as serious as it was for the treatment to be so easy," said Rogers, of Oakland, Tenn. He left Baptist Memorial Hospital the next day and was back at work five days later.
The device, dubbed a Rotablator, won Food and Drug Administration approval in 1993. Manufactured by Heart Technology Inc. of Bellevue, Wash., Baptist physicians began using the device in January.
"Everyone believes most patients will continue to be treated with balloon angioplasty. We will reserve this for people who aren't balloon candidates," said Dr. Stephen Cook, a Baptist heart specialist.
Heart disease remains the nation's leading killer. In 1991, the most recent year for which federal statistics are available, an estimated 407,000 heart bypass surgeries and another 331,000 balloon angioplasties were done nationwide.
Bypass surgery involves bypassing the narrowing with a blood vessel, often taken from the patient's leg, sewn onto arteries carrying the heart's blood supply.
Balloon angioplasty involves threading a balloon-tipped catheter through a vein in the patient's groin to the heart narrowing. The balloon is then inflated, compressing the fatty deposits, thus increasing the heart's blood flow.
In recent years, lasers and a shaving device have been added to the tools available for widening narrowed arteries.
Cook said currently the Rotablator is reserved for patients like Rogers who aren't candidates for other options. Those include patients with long or unusual blockages or calcium-hardened blockages, he explained.
The Rotablator is smaller and revolves much faster, meaning it will fit through smaller vessels and bore through calcium, he said. The risks are similar to those associated with angioplasty, including emergency bypass surgery, Cook said.
It's also more expensive than balloon angioplasty, he said. The drills cost about $1000 each compared with about $700 for the balloon catheters used in balloon angioplasty.
So far more than 20 patients have undergone the procedure, with minor complications, he said.
Judi DeFranco, Methodist Heart Institute's executive director, said Methodist doctors are scheduled to begin using the devices this week. "It is a real promising new technology," she said.
"There's always a risk the narrowing will come back," said Dr. Stevan Himmelstein, another Baptist heart specialist. Nationwide, about 25 percent of arteries re-narrow after such treatments.
He said the drill leaves a smoother surface, thus reducing the odds of blood clots.