Management of the limitations in low-speed rotational transluminal angioplasty: technical note

The low-speed rotational transluminal angioplasty catheter system (ROTACS) is a recently available device for recanalization of occlusions prior to balloon angioplasty. The presence of large collaterals originating just proximal to the occlusion with an acute angle, and insufficient space between the puncture site and the occlusion for placing an introducer sheath are reported to be limitations for ROTACS. To avoid the rotating catheter entering the collateral, we propose a technique to create a pilot inlet on the proximal aspect of the occlusion. This technique was applied successfully in 4 patients. A contralateral approach was used in 3 patients, in whom an ipsilateral access was not possible because of the insufficient space to place an introducer sheath.