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Published on: February 26, 2013
Current status of rotational atherectomy
Erdal Cavusoglu1, Annapoorna S Kini, Jonathan D Marmur
1Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA.
Insights
Rotational atherectomy effectively treats complex coronary lesions resistant to balloon angioplasty or stenting by ablating plaque. This technique offers a valuable option for challenging cases, improving outcomes in obstructive coronary artery disease.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Percutaneous transluminal coronary angioplasty and stenting are common treatments for obstructive coronary artery disease.
- Certain complex lesions, like heavily calcified or fibrotic ones, are difficult to treat with angioplasty or stenting alone.
- Inadequate treatment can lead to vessel dissection or incomplete stent deployment, resulting in adverse outcomes.
Purpose of the Study:
- To review the technique, principles, and applications of rotational atherectomy for complex coronary lesions.
- To discuss treatment strategies, including adjunctive pharmacotherapy and lesion-specific uses.
- To outline unique complications and provide recommendations for its use in interventional cardiology.
Main Methods:
- Review of existing literature and clinical practices regarding rotational atherectomy.
- Discussion of the mechanism of plaque ablation versus displacement.
- Analysis of specific lesion types amenable to rotational atherectomy.
Main Results:
- Rotational atherectomy removes plaque by ablation, unlike balloon angioplasty or stenting which displace it.
- It is effective for undilatable lesions, ostial lesions, chronic total occlusions, and in-stent restenosis.
- The device serves as a crucial adjunct to balloon angioplasty and stenting for complex cases.
Conclusions:
- Rotational atherectomy is a valuable niche device for percutaneous treatment of complex coronary lesions.
- It offers an alternative mechanism for lumen gain by ablating atherosclerotic material.
- Proper technique and patient selection are key to optimizing outcomes and managing complications.
Abstract:
Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era.
