Rotational atherectomy in everyday clinical practice. Association of Cardiovascular Interventions of the Polish Society of Cardiology (Asocjacja Interwencji Sercowo-Naczyniowych Polskiego Towarzystwa Kardiologicznego — AISN PTK): Expert opinion

Abstract

The common use of stents, including antiproliferative drug-eluting stents, has been a major breakthrough in invasive cardiology. Nowadays, a change in the clinical presentation of patients treated with percutaneous coronary intervention (PCI) is observed. The typical clinical characteristics now include advanced age, diabetes, chronic kidney disease, heart failure, and multilevel atherosclerosis. Age, diabetes, and chronic kidney disease are the main predictors of coronary artery calcifications. Severe coronary artery calcifications are the main factor limiting the efficacy of PCI. Successful stent implantation is challenging in the presence of calcifications, because it is difficult to achieve full stent expansion and proper stent apposition. Therefore, it is necessary to adequately prepare the lesion before stent implantation. This document presents the technique of rotational atherectomy (rotablation) as well as indications for and contraindications to the procedure, along with its possible complications and their prevention. Training in rotablation for operators as well as reimbursement policy for the procedure in Poland are also discussed.

Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

“…The unification of indications, contraindications, atherectomy device choice and technique of debulking procedure, according to peer-reviewed expert opinion based on trials and registries could improve outcomes after revascularization with atherectomy in PAD, as has already happened in the coronary field [13].…”

Acute Angulation and Sequential Lesion Increase the Risk of Rotational Atherectomy Failure

“…The median burr-toartery ratio was relatively low (0.44), which was proven to be effective enough for plaque modification according to the expert consensuses on RA. 15 One-third of our patients were disqualified from CABG treatment by a local Heart Team, meaning that we analyzed a real-world, high-risk group of patients, with frequent RA use as the last revascularization option. Nonetheless, despite an additional inclusion to our study group also patients in whom a successful introduction of rota-wire or burr across the lesion failed, the procedural and clinical success was 85.8%.…”

The power of gold: a tip for an uncrossable ostial lesion

“…Most of the documented methods cannot be applied in true aorto-ostial lesions with severe stenosis. Such lesions require a nonstandard approach that has not been precisely described in any expert documents so far [2][3][4].…”