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8/14/2019 Rotational my

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Rotational ArtherectomyRotational Artherectomy

Interventional ConferenceInterventional Conference


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Why rotational artherectomy?Why rotational artherectomy?

Balloon angioplasty often unsuccessful in certainBalloon angioplasty often unsuccessful in certainlesions:lesions: Calcified lesionCalcified lesion unable to dilateunable to dilate

Bifurcation lesionBifurcation lesion

plaque shiftingplaque shifting ISRISR

Decrease procedural success rate in type B andDecrease procedural success rate in type B and

C lesionsC lesions increase risk for adverse outcomeincrease risk for adverse outcome Increase rate of failed proceduresIncrease rate of failed procedures


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Why rotational artherectomy?Why rotational artherectomy?


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OverviewOverview

EquipmentEquipment

Technical PrinciplesTechnical Principles

Procedural issuesProcedural issues TrialsTrials

Lesion specific managementLesion specific management


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Listen to deviceRotational speed (150,000 rpm)


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PreparationPreparation


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Know LV Fx: there could be transient stunning of wall (upto 30 min).

So if there is low LV function, patient can get hypotensive.


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Planning procedurePlanning procedure

Guide-cath:Guide-cath: 8F guide (upto 2.15 burr)8F guide (upto 2.15 burr) Need good support and coaxialNeed good support and coaxial

Guidewire:Guidewire: Use tradition wire and switch it to rota-wire over balloon.Use tradition wire and switch it to rota-wire over balloon.

Burr:Burr: Traditional 1.5-2.5 burrTraditional 1.5-2.5 burr Ideally keep Burr to artery ratio:


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Burr SpeedBurr Speed

Speed 140,000 produces small particles

Speed >180,000 causes increase pltSpeed >180,000 causes increase pltaggregationaggregation

Drop of >5000 rpm: may produceDrop of >5000 rpm: may produce

excessive heat (avoid)excessive heat (avoid)


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TrialsTrials

ERBACERBAC

SPORTSPORT

DARTDART ARTISTARTIST


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ERBACERBAC

6 month follow up6 month follow up


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DARTDART Randomization between rotational atherectomy versus PTCA for type A andRandomization between rotational atherectomy versus PTCA for type A and

B1 coronary lesionsB1 coronary lesions


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ARTISTARTIST


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ResultsResults


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Results: during cath observationResults: during cath observation


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ComplicationsComplications


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Acute angiographic resultsAcute angiographic results


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Results: angiographic QCAResults: angiographic QCA


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ARTISTARTIST

InterpretationInterpretation

For the treatment of diffuse in-stentFor the treatment of diffuse in-stent

restenosis, PTCA alone was associatedrestenosis, PTCA alone was associated

better long-term outcomes than rotationalbetter long-term outcomes than rotationalatherectomy followed by adjunctive low-atherectomy followed by adjunctive low-

pressure PTCA.pressure PTCA.


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SPORTSPORT


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Trial SummaryTrial Summary

Majority compare PTCA and RotablatorMajority compare PTCA and Rotablator Not real life practice in era of stentsNot real life practice in era of stents

SPORT trial ( only practical study)SPORT trial ( only practical study)

4 trial show no significant in adverse4 trial show no significant in adverse

increase except ARTISTincrease except ARTIST

No clinical benefit (death,MI,TVR)No clinical benefit (death,MI,TVR)

Increase procedural success rate withIncrease procedural success rate with

comparable safety/complicationcomparable safety/complication


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CalcificationCalcification

***Special mention for RCA-ostial Calcified lesion

High risk for dissection. Therefore highly recommended to debulk

with rotoblator.

***PTCA of Calcified lesion can cause dissection at the edge (upto 50-60%)

Rotoblator can reduced the incidence to 22%

(safian 3rd edition)


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Bifurcation lesionBifurcation lesion


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SummarySummary

Equipment setup is cumbersome:Equipment setup is cumbersome: more you use it, better it is.more you use it, better it is.

Useful tool for complex cases:Useful tool for complex cases: Faster you decide to use it, easier the case.Faster you decide to use it, easier the case.

Rotablator has it place in certain lesions:Rotablator has it place in certain lesions: Calcified, ISR, and ostial lesionsCalcified, ISR, and ostial lesions

From trial prespective:From trial prespective: increases procedural success rate with comparable risk/benefitincreases procedural success rate with comparable risk/benefit

to PTCA.to PTCA.

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