ROTABLATION (ROTATIONAL ATHERECTOMY) MUST KNOW PROCEDURAL ASPECTS

Rotational atherectomy is a time tested, useful and effective technology when it comes to calcific coronary lesions. This tool has been a part of interventional cardiologists arsenal for a long time but now there is an increase in its demand. With increasing age and presence of comorbidities like diabetes, hypertension and renal failure the incidence of calcific lesions in coronary artery disease is increasing. This article is meant to review the basic procedural setup, principles for safety and tips and tricks. The core elements for successful and safe technique being the use of the smallest size burr needed to achieve plaque modification with burr to artery ratio of 0.6, gradual advancement in a pecking motion, rotational speed of around 140,000-180,000 RPM, decelerations of less than 5000 RPM, short ablation runs of 15-20 seconds with continuous saline, nitrate, heparin and verapamil irrigation throughout ablation and finished with a polishing run. Keywords: Rotational atherectomy, Rotablation, calcific coronary lesions, Complex percutaneous coronary intervention (PCI)