Rotational atherectomy: Technical update
Paula Mota1, Adam de Belder2, António Leitão-Marques1
1Cardiovascular Intervention Unit, Coimbra University Hospital Centre, Coimbra, Portugal.
Insights
Rotational atherectomy (RA) has evolved from plaque removal to a less aggressive technique for treating calcified coronary artery disease. Modern RA improves stent delivery and long-term outcomes in complex lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention is a common treatment for symptomatic coronary artery disease.
- Elderly, diabetic, and renal patients often have complex calcified coronary lesions.
- Rotational atherectomy (RA) is a technique used to treat these challenging lesions.
Purpose of the Study:
- To review the evolution and current technique of rotational atherectomy (RA).
- To highlight RA's role in preparing calcified lesions for percutaneous coronary intervention.
- To discuss the shift towards a more conservative RA approach.
Main Methods:
- Review of historical and current literature on rotational atherectomy.
- Analysis of the changing mechanisms and techniques of RA.
- Discussion of RA's adjunctive role with drug-eluting stents.
Main Results:
- Early RA focused on plaque removal with high-velocity, large burrs, leading to complications.
- Drug-eluting stents reduced restenosis, repositioning RA as a lesion preparation tool.
- Current RA uses smaller burrs and lower speeds, enhancing safety and outcomes.
Conclusions:
- Rotational atherectomy has transformed into a compliance-modifying technique.
- A less aggressive RA approach improves stent delivery, expansion, and long-term results.
- RA is a valuable adjunctive therapy for complex calcified coronary lesions.
Abstract:
Percutaneous coronary intervention is currently the most common form of revascularization for symptomatic coronary artery disease. In elderly, diabetic and renal patients, there is an increased prevalence of calcified coronary disease. Rotational atherectomy (RA) can be useful in the treatment of these lesions. Plaque removal was initially proposed as an alternative to balloon angioplasty, hence RA required high-velocity protocols with large-sized burrs (over 2.0 mm). With a high incidence of acute complications and disappointing restenosis rates, the use of RA dwindled. However, the advent of drug-eluting stents, which significantly decreased the rate of restenosis, led to the repositioning of RA as an adjunctive technique in the preparation of densely calcified lesions, improving stent delivery and expansion. In recent years, a better understanding of the mechanism of action of RA has changed it from a plaque debulking to a compliance modifying technique. As a result, RA has become less aggressive, using smaller size burrs and lower rotational speeds. This conservative approach has improved immediate results, with increased safety and better long-term outcomes. In this review paper, the technique of RA is explained in the light of current knowledge.
