Rotational atherectomy

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Overview

Rotablation is used as a debulking device. It is generally not used as a stand alone device.

Indications

1. Native vessel
2. Calcified or fibrotic lesions: undilatable
3. Ostial lesions
4. Bifurcation lesions: debulking
5. Lesions that can not be crossed with the primary device

Strategies to reduce no reflow during the procedure

1. Liberal administration of calcium channel blockers such as diltiazem (200 micrograms administered via the intracoronary route)
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
7. Use of a "Rotablator flush":

• 0.9% NS 1000 cc
• 10,000 Units of unfractionated heparin (10 units / ml)
• Verapamil 10 mg (10 micrograms / ml)
• Nitroglycerin 5 mg (5 microgams / ml)

Efficacy

The comparative efficacy of rotational atherectomy has been compared in the following studies / trials:

1. SPORT Trial: This trial Randomized 735 patients to bare metal stenting with or without prior rotational atherectomy. THere were better acute results among patients pre treated with rotational atherectomy. There was no difference in TLR rates in follow-up