Basic principles of rotablation

Basic principles of rotablation Rotablation or rotational atherectomy uses a diamond coated burr to debulk complex atherosclerotic plaques which are difficult to treat with conventional balloon angioplasty. The physical principle of rotablation is differential cutting. The advancing rotablator burr selectively cuts inelastic material while elastic tissue deflects away from the burr. As 95% of the particles generated by rotablation are less than 5 microns in diameter, they are removed from the body by the reticuloendothelial system [1]. Thus the basic principle of rotablation is quite different from balloon dilatation in which there is displacement of atherosclerotic plaque with multiple tears [2]. Though it was initially used as a debulking strategy, later the emphasis was on plaque modification prior to stent implantation. Rotablation facilitates percutaneous coronary intervention (PCI) for de novo complex lesions with severe calcification. Burr to artery ratio of 0.5 to 0.6 and rotational speed of 140,000 to 150,000 rpm have been suggested. The burr should be advanced gradually with a pecking motion (quick push forward/pull back movement of the burr). Short ablation runs of 15 to 20 seconds and avoidance of decelerations more than 5,000 rpm are also suggested. Other adjunctive measures are the use of antiplatelet agents, vasodilators, flush solutions, and temporary pacing, vasopressors and mechanical support when needed [3]. Due to changes in conceptual understanding of th...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Coronary Interventions Source Type: blogs