ABSTRACT
Rotational atherectomy (RA) has been well described as a device effective in plaque modification that specifically increases vessel compliance and permits the transit of balloons and stents in heavily calcified arteries, despite a demonstrated increased minimal luminal diameter on the final angiogram when stenting is performed with adjunctive RA. The role of RA in chronic total occlusions (CTOs) is ultimately based on the success of crossing the lesion with the guidewire. Differential cutting, the hallmark of the RA system, refers to the ability of the burr to ablate or ‘sand’ inelastic material while sparing elastic tissue. The initial crossing of the CTO should be carried out in the safest and efficacious way in order to maximally assure the positioning in the true lumen throughout. Utilization of RA can be invaluable in certain CTO cases with very long and hard or uncrossable lesions. Innovative approaches need to be employed in order to safely place the special Rotablator wire in distal lumen.
