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This is performed in patients with very calcified hardened blockages (atherosclerotic plaques) involving long segments of the blood vessel, where angioplasty alone may not be sufficient. A special catheter device (either with high-speed rotating shaft and blades at tip or laser) is introduced under X-ray guidance over a wire into the blocked segment. Then the device is turned on which breaks off the hardened plaques and creates a channel through the blockage. Subsequently a balloon catheter is used to stretch the newly created channel to allow the blood flow through it. Stenting may also be performed if needed.