Rotational Atherectomy

Rotational atherectomy is used most often to treat stenoses that are calcified, located at an arterial ostium or at the site of a bifurcation, or resulting from in-sent restenosis. The atherectomy device debulks soft and calcified plaque while minimizing injury to adjacent normal arterial segments. In a randomized comparison with excimer laser and balloon angioplasty, rotational atherectomy achieved a statistically higher procedural success rate without an increased incidence of major complications. Patients with lesions that were more complex derived the greatest benefit from rotational atherectomy. To date, rotational atherectomy usually is performed in conjunction with a) the intracoronary infusion of a "cocktail" containing verapamil, heparin, and nitroglycerin; b) the intravenous infusion of a glycoprotein IIb/IIIa receptor antagonist, such as abciximab; c) a stepped burr approach, leading to a burr:artery ratio of 0.8; d) burr rotations <30 seconds in duration; e) avoidance of burr deceleration; and f) low-pressure balloon angioplasty. Under these circumstances, it has a procedural success rate of 98% and a major complication rate of <2%.