Rotational atherectomy

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Strategies to reduce no reflow during the procedure

1. Liberal administration of calcium channel blockers such as diltiazem (200 micrograms intracoronary)
2. Multiple short runs of rotablation
3. A slower initial speed of rotablation such as 140,000 to 160,000 rotations per minute (RPM)
4. Minimal deceleration during the bur runs
5. Allowing a period of recovery between bur runs
6. Avoid over-sizing the bur to minimize downstream embolization