There are three forms of coronary atherectomy:

• During a rotational atherectomy, the physician uses a rotablator equipped with a “burr” at the tip. The rotablator is inserted into the coronary artery where the blockage is located. Once activated, the burr rotates as fast as 200,000 revolutions per minute, allowing the physician to drill through the arterial blockage, grinding the plaque into very small particles. In most cases, these microparticles can travel safely through the circulatory system. This technique is useful for harder, calcified plaque. It is the most common kind of atherectomy.
  
  
  
   
• During a transluminal extraction, the physician uses a transluminal extraction catheter (TEC) equipped with tiny rotating blades and a hollow tube. As plaque is cut away from the artery wall, it is sucked into the tube by a vacuum and expelled from the body. This technique is useful for blockages containing blood clots.
  
  
  

Another form of transluminal extraction can be performed with a device known as an Angiojet. Like the TEC device, the Angiojet is a sucking/vacuum device. Rather than cutting away the plaque and blood clots, the Angiojet dislodges them with a high-velocity stream of saline solution that is directed back into the catheter, dragging the debris with it.

These two devices are of particular use in previously placed bypass grafts that are larger than natural coronary arteries. These bypass grafts often have debris from plaque and blood clots that might otherwise be showered downstream into the relieving vessel if angioplasty and/or stenting are done alone.