Rotational percutaneous atherectomy (Rotablator)



Atherectomy means removal of atheroma plaque. This is a surgical term, as plaque initially could only be resected by surgery. The idea of percutaneous (via femoral puncture) intracoronary atherectomy arose in the 1980s. Excisional atherectomy used a blade in a catheter to resect and remove plaque. The advantage of this lied in the possibility of obtaining material and analysing its content, which lead to many new concepts regarding atherogenesis and how to treat coronary disease. On the other hand, it caused too much arterial damage, leading to a high incidence rate of heavy scarring that led to restenosis (30-40%).

Rotational percutaneous atherectomy (Rotablator)

At the same time, a new type of percutaneous atherectomy arose; it was rotational (Rotablator). The plaque resection mechanism through the catheter consists of fragmentation into tiny particles by drill that rotates at 180000 rpm. The drill is fitted with diamond particles that are responsible for breaking plaque down into tiny fragments (microns) that are embolised by the coronary blood flow, and the atheromatous material is not recovered. The drill cuts hard areas without damaging the soft parts of the plaque or blood vessel. The fragments are so small that most of them can pass through coronary capillary veins. In some cases, they can lead to major embolisations that obliterate some capillary vessels and cause the condition known as “Non-Reflow”, which is normally temporary.

The first technique disappeared with the onset of stents, and Rotablator is now a secondary or preparatory technique to provide access to the affected area with stents. In some patients, the degree of plaque calcification is so high that access with a balloon catheter for pre-dilation purposes is extremely difficult. If we open the sides of the obstruction with a guide, and a small drill passes through them at a high speed, it removes the most important parts and thus provides an access route for a balloon and/or a stent. The best material for the use of a drill is precisely calcium. Highly calcified plaque can require the use of a Rotablator. Although used only occasionally, it is essential for coronary intervention groups.


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Cardiólogos - Grupo Corpal
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