Review of research on arterial vascular calcified plaque grinding

Abstract

SignificancePlaques are clogging deposits formed by the accumulation of fat and calcium on the inner walls of arteries. Their formation can lead to narrowing the inner diameter of the blood vessel and hardening the blood vessel wall, thereby limiting blood flow and inducing various cardiovascular diseases such as coronary heart disease and peripheral arterial disease. Numerous factors, such as lifestyle changes and population aging, have lead to an increase in the number of patients with cardiovascular disease in China in recent years. The annual growth rate of vascular interventional therapy has remained at around 17% for a decade due to the continuous development of interventional medical means. China's large population of vascular disease and the special situation of calcified plaque lesions have created a huge demand for rotational interventional therapy. By analyzing the current research on rotary grinding, this paper summarizes the existing deficiencies and suggests a follow-up research direction to accelerate the exploration of rotary grinding's mechanism and master the core technology theory. Progress: Firstly, the research on rotary grinding instruments is summed up in three parts: (1) The rotary grinding therapeutic apparatus mentioned here contains a description of its basic features, including the RA from Boston Science and the OA from CSI. The differences between the two were compared in terms of technical indications, clinical indications, mechanism of action, and product upgrades. (2) The preparation method for the grinding wheel and the differential cutting of the grinding wheel are presented in summary. Currently, grinding wheels are mostly created by electroplating, and some experts have suggested using the "engraving" technique. Differential grinding wheel cutting involves two primary principles. Boston Science proposed differential cutting that utilizes the theory of workpiece deformation during the cutting process of flexible materials. The second mechanism is based upon the theory of the dynamic pressure film in water. (3) A summary was provided regarding the structure and techniques of two different types of special rotary grinding guide wires, as well as the potential negative consequences during operation. Secondly, the differences between treatments are compared, such as rotational atherectomy, conventional balloon stenting, rotational resection, ELCA and shock wave balloon. The advantages of plaque rotary grinding are explained in detail. The likelihood of occurrence, explanations, methods of treatment, and other research on complications following rotational grinding are evaluated and summarized. Slow/non-reflow, vascular dissection, vascular perforation, grinding head incarceration, guide wire bias, etc., are all included. Engineering proposes controlling grinding parameters and improving the performance of related equipment to reduce the probability of complications. Finally, the research related to the mechanism of rotary grinding is examined. The main factors are rotary grinding force, rotary grinding heat, and rotary grinding debris. The grinding force is analyzed in a specific way by the current research, which focuses on the impact of grinding wheel speed and quality, blood vessel diameter, fluid dynamic pressure, and other factors on the grinding force. Research on rotary grinding heat focuses on reducing temperature through liquid scrubbing, but there is limited attention paid to thermal damage from an engineering perspective. The analysis of the wear debris mostly discusses the relationship between the size and the speed of the grinding wheel.Conclusions and Prospects(1) At present, the rotary grinding device and related consumables are all imported from the United States. In the future, Chinese substitution will be an important development direction. The development of Chinese rotary grinding products is under process now. (2) The study of the differential cutting mechanism and the design of the surface characteristics of the rotary grinding head to achieve non-invasive vascular tissue removal and efficient plaque tissue removal plays an important role in reducing other injuries caused by surgery. (3) The safety of the grinding process could be improved by optimizing the grinding parameters. There are few discussions on whether other factors in the grinding process will affect parameters such as grinding force, grinding debris and grinding heat. This is the direction of continuous research. (4) There are few theoretical studies on the grinding guide wire, and the performance of the guide wire is the main factor in determining whether it is biased or broken during the operation. Explore the possibility of processing different materials into high-performance grinding guide wires and new processing methods. On the premise of ensuring product performance, minimizing device costs and surgical costs is also a key research direction in the future. (5) According to the characteristics of plaque removal, the development of new products with better performance, such as laser plaque ablation products, shock wave balloons, etc., is also very marketable.

Keywords

• rotational atherectomy
• rotary grinding device
• rotary grinding mechanism
• differential cutting
• complications