ABSTRACT
Introduction Rotational coronary atherectomy was developed by Auth in the early 1980s as an alternative to percutaneous transluminal coronary angioplasty (PTCA).1 The Rotablator™ device was approved for the treatment of obstructive coronary artery disease in Europe and the United States in the early 1990s. The mechanism of the Rotablator is uniquely different from other percutaneous revascularization devices. The device uses sized burrs coated with 10 µm diamond chips. The burr rotates at high speed over a guidewire and abrades atherosclerotic plaque into micro-particles that are delivered to the distal coronary circulation. The abrasive surface of the burr allows selective cutting of hard, calcified plaque, while the softer, elastic components of the normal vessel wall are deflected away from the burr, preventing damage. Early clinical trials with the Rotablator showed that it was a safe and effective treatment modality with particular efficacy in the treatment of calcified lesions.2,3
Advancements in rotational atherectomy (RA) over the past 5 years include refinement of equipment, changes in technique, and developments in adjunctive pharmacology. Continuing experience with rotational atherectomy has defined ideal lesion subsets for treatment and synergy between the Rotablator and other devices. This chapter will focus on the major developments and changes in rotational atherectomy since the last publication of this text.
