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Published on: May 29, 2015
Rotational atherectomy
K E Saland1, J E Cigarroa, R A Lange
1University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9047, USA.
Insights
Rotational atherectomy effectively treats complex arterial stenoses, including calcified lesions and in-stent restenosis. This plaque-debulking technique offers high procedural success rates with minimal complications, especially in challenging cases.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Rotational atherectomy is a key technique for managing complex arterial stenoses.
- Indications include calcified lesions, ostial or bifurcation sites, and in-stent restenosis.
- The device debulks plaque while preserving adjacent healthy arterial tissue.
Purpose of the Study:
- To evaluate the efficacy and safety of rotational atherectomy.
- To compare rotational atherectomy with other revascularization methods.
- To identify patient populations that benefit most from this intervention.
Main Methods:
- Randomized comparison with excimer laser and balloon angioplasty.
- Standardized procedural adjuncts: intracoronary infusions (verapamil, heparin, nitroglycerin), glycoprotein IIb/IIIa antagonists (e.g., abciximab).
- Specific technique parameters: stepped burr approach (burr:artery ratio 0.8), short burr rotations (<30 seconds), avoidance of deceleration, low-pressure balloon angioplasty.
Main Results:
- Rotational atherectomy demonstrated a statistically higher procedural success rate compared to alternatives.
- No significant increase in major complications was observed.
- Patients with more complex lesions experienced the greatest benefits.
Conclusions:
- Rotational atherectomy is a highly effective treatment for complex arterial stenoses.
- When performed with current adjuncts and techniques, it achieves a 98% procedural success rate and <2% major complication rate.
- This method offers significant advantages, particularly for patients with challenging lesion characteristics.
Abstract:
Rotational atherectomy is used most often to treat stenoses that are calcified, located at an arterial ostium or at the site of a bifurcation, or resulting from in-stent restenosis. The atherectomy device debulks soft and calcified plaque while minimizing injury to adjacent normal arterial segments. In a randomized comparison with excimer laser and balloon angioplasty, rotational atherectomy achieved a statistically higher procedural success rate without an increased incidence of major complications. Patients with lesions that were more complex derived the greatest benefit from rotational atherectomy. To date, rotational atherectomy usually is performed in conjunction with a) the intracoronary infusion of a "cocktail" containing verapamil, heparin, and nitroglycerin; b) the intravenous infusion of a glycoprotein IIb/IIIa receptor antagonist, such as abciximab; c) a stepped burr approach, leading to a burr:artery ratio of 0.8; d) burr rotations <30 seconds in duration; e) avoidance of burr deceleration; and f) low-pressure balloon angioplasty. Under these circumstances, it has a procedural success rate of 98% and a major complication rate of <2%.
