Update on Rotational Atherectomy

Abstract

The Rotablator (Heart Technology, Inc., Redmond, WA, USA) atherectomy catheter, in essence, is a sanding device. Its effect is related to the size of the diamond particles and the force with which they are applied to the lesion. It removes calcified atheroma, which is the primary mechanism of lumen enlargement (vs vessel stretching), without causing recoil on 24‐hour angiography following rotational atherectomy. Rotational atherectomy finds its greatest use in patients with smaller vessels, calcified lesions, and complex or long coronary artery disease. These patients require a large armamentarium of devices and approaches to achieve optimal results. The ability to combine atherectomy, angioplasty, and stenting in these complex lesion subsets promises the best short‐term results and the largest lumen diameters with least residual stenoses and the best potential for good acute results and durable long‐term results.