CARDIOVASCULAR PROCEDURES << BACK Rotational Atherectomy In a small number of cases, a special catheter (a long, narrow, flexible tube) with a small, diamond tip is used to drill through hard plaque and calcium that is causing the blockage in the vessels around the heart. This is called rotational atherectomy. The procedure uses a high speed rotational "burr" that is coated with microscopic diamond particles. The burr rotates at high speed, breaking up plaque into tiny fragments that can pass easily into the blood stream. Pain medication is usually given before the procedure begins and sometimes a blood thinning medication also will be given. A small incision is made, usually near the groin, where the catheter is inserted. The heart and arteries will be visible using an X-ray machine. Dye is injected into the body to highlight blood flow through the arteries, revealing any blockages in the vessels leading to the heart. Risks are low, similar to those for angioplasty, including reactions to medications or problems breathing, both related to the risk of any anesthesia. Bleeding and infection are also a risk, as are obstruction of blood flow, damage to a valve or vessel. There is a slight risk of stroke, arrhythmia, kidney failure, and death associated with the procedure.