Hand-Assisted Rotational Atherectomy for Severe and Long Superficial Femoral Artery Calcification: A Step-by-Step
Jen-Kuang Lee1, Hung-Chi Su2, Po-Chao Hsu3
1Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Objectives:
Hand-assisted rotational atherectomy (HARA) using a 2.0-mm burr is an innovative approach for treating severely calcified superficial femoral artery (SFA) lesions, enhancing procedural success and facilitating optimal revascularization.
Key Steps:
The key steps are as follows: 1) ultrasound-guided antegrade femoral access; 2) controlled rotational atherectomy passes at 140,000 to 160,000 rpm; 3) manual compression applied opposite the burr to enhance targeted debulking; and 4) drug-coated balloon angioplasty or drug-eluting stent deployment.
Potential Pitfalls:
Burr entrapment can be mitigated by avoiding excessive force and allowing gradual advancement.
Take-Home Message:
HARA is a safe, effective, and reproducible technique for treating severely calcified SFA lesions, improving procedural success and optimizing outcomes with drug-coated balloon angioplasty or deployment of a drug-eluting stent.
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