High-speed rotational atherectomy for chronic total coronary occlusions

Treatment of chronic total occlusions remains a limitation of percutaneous revascularization and is associated with lower immediates success and higher long-term restenosis rates compared to less severe stenoses. While part of the problem in dealing with total occlusions relates to successfully passing a wire across the occluded segment, most chronic occlusions contain large plaque burdens. Balloon dilatation sometimes falls to restore antegrade flow and often yields suboptimal angiographic results in these situations. Rotational atherectomy has proven useful in treating calcified and diffusely-diseased vessels and appears attractive for debulking lesions with large atheromatous plaques. We report our experience using rotational atherectomy in treating chronic total occlusions.