Guidewire bias: potential source of complications with rotational atherectomy

The guidewire in rotational atherectomy is an integral component in the ablative process. It functions not only to deliver the device but sets the cutting vector when the burr advances. Since the guidewire is a stiff stainless steel monofilament and the vessels are frequently tortuous and angulated, the guidewire may not be centrally oriented, but may bias preferentially to one side of the arterial wall. This may result in tangential or radial cutting. The following cases illustrate the dependence of the ablative process on the lie of the guidewire and the importance of integrating this factor in proper use of the Rotablator system.