Technique and strategy of rotational atherectomy

Atherosclerotic plaque heterogeneity has created the need for the development of second generation devices aimed specifically at lesions where PTCA has been shown to be suboptimal. The Rotablator system represents one of the newer technologies which utilizes plaque ablation to achieve larger lumens. The device is a high speed "rotary sander," which requires the interventional cardiologist to be keenly aware of the mechanical implications while advancing the device through the coronary vasculature. The objective of this article is to review the most recent technique refinements and strategies for rotational atherectomy as well as the available clinical data and ongoing clinical trials.