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Current status of rotational atherectomy.

Matthew I Tomey1, Annapoorna S Kini1, Samin K Sharma1

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Summary

Rotational atherectomy is a key technique for severe calcified coronary lesions. Optimal technique and complication management are crucial for safe and effective percutaneous coronary intervention, especially with modern drug-eluting stents.

Keywords:
calcified lesionscomplicationsdrug-eluting stentsrotational atherectomy

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Rotational atherectomy is used for complex, calcified coronary lesions during percutaneous coronary intervention.
  • Its routine use has not reduced restenosis or major adverse cardiac events.
  • The procedure is technically demanding and infrequently performed.

Purpose of the Study:

  • To review the current state-of-the-art in rotational atherectomy.
  • To evaluate technique, safety, and efficacy in the era of drug-eluting stents.
  • To discuss complication prevention and management, and appropriate use in stable ischemic heart disease.

Main Methods:

  • Review of current literature and clinical trial data.
  • Analysis of optimal rotational atherectomy techniques.
  • Evaluation of strategies for preventing and managing complications like slow-flow/no-reflow and burr entrapment.

Main Results:

  • Optimal technique involves specific burr-to-artery ratios, rotational speeds, and ablation strategies.
  • Meticulous technique combined with supportive therapies minimizes slow-flow/no-reflow (0.0%–2.6%).
  • Recent trials suggest alternative treatments like medical therapy or bypass surgery for some complex coronary artery disease patients.

Conclusions:

  • Rotational atherectomy remains appropriate for specific de novo severely calcified lesions.
  • Referral to centers of excellence is recommended for optimal outcomes.
  • Careful patient selection and procedural technique are paramount.