Oct 20, 2020 rotational atherectomy ra has been widely used for percutaneous coronary intervention pci to severely calcified lesions. Aug 02, 2020 rotational atherectomy ra is an important diseasemodifying strategy utilized in percutaneous coronary intervention pci in patients with calcified coronary artery disease. Rotational atherectomy followed by des implantation is a safe and effective technique for patients with complex. Rotational atherectomy uses a rotating diamondcoated burr to abrade atherosclerotic plaque at speeds as high as 180 000 rpm. The rotapro rotational atherectomy system console regulates the flow of air to the advancer, controlling burr rotation speed. Boston scientific, natick, ma has been commercially available for use in the coronary arteries for the past 3 decades. Photographs of the rotablator rotational atherectomy system foot pedal, console, and advancer. A short video demonstrating how boston scientifics rotablator rotational atherectomy system works.
The invention provides a rotational atherectomy system, device and method comprising a flexible, elongated, rotatable drive shaft with a precurved abrasive section disposed within a catheter that deforms the abrasive section to a substantially straight profile and, when the abrasive section is moved distally out of the catheter, the abrasive section resumes its precurved profile. This concise practical guide is designed to facilitate the clinical decisionmaking process in the management of rotational atroctomy procedures by examining a number of cases and defining various diagnostic and management decisions for physicians. Rotational atherectomy system precise boston scientific. Rotational atherectomy is used most often to treat stenoses that are calcified, located at an arterial ostium or at the site of a bifurcation, or resulting from instent restenosis.
Rotablator system reference guide boston scientific. The rotablator rotational atherectomy system figure 1. Then, the use of distal anchoring balloon warranted support and tracking, made as centring rail for the advance of the tip of the motherandchild catheter into the svg. Directional atherectomy may be best suited for certain lesion subsets less amenable to stenting, such as bifurcation lesions, ostial stenoses, or instent restenosis. To our knowledge, this is the first case report of stent ablation for an unexpanded paclitaxel. Atherectomy is now widely used both in the femoropopliteal and belowknee vessels with varied results, and multiple devices are fda approved and available.
Peripheral artery disease, atherectomy, lumivascular atherectomy is a minimallyinvasive method of removing plaque to open up arteries blocked with plaque. Rotational atherectomy has long been regarded as contraindicated for stenotic lesions within the body of saphenous vein grafts. Rotational atherectomy is one of several ways to perform atherectomy in a coronary vessel. Rotational atherectomy for peripheral artery disease. Jun 19, 2018 an elective transradial pci of svg on rca with rotational atherectomy was performed. High speed rotational coronary atherectomy for patients with. Rotational atherectomy in the clinical setting seems challenging because of the risk of coronary slow flow that can lead to haemodynamic instability, particularly in case of severe as. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head. Clinical expert consensus document on rotational atherectomy. Comparison of bailout and planned rotational atherectomy for. A strategy of routine rotational atherectomy has not, however, conferred reduction in restenosis or major adverse cardiac events. A polymer driveshaft for use in orbital and rotational. Rotational atherectomy in arteries with extreme calcification or. Rotational atherectomy ra is an important diseasemodifying strategy utilized in percutaneous coronary intervention pci in patients with calcified coronary artery disease.
Rotational atherectomy involving the left main coronary artery. Us91087b2 directional rotational atherectomy device with. At least part of the eccentric enlarged abrading heads in the system have a tissue removing surfacetypically an abrasive surface. Rotational atherectomy ra is an atheroablative technology that enables. Rotablation is a widely used technique for the treatment of complex coronary artery lesions but is so far only poorly supported by controlled studies. Heterogeneity exists, however, in ra utilization and technique.
Us91087b2 directional rotational atherectomy device. Orbital and rotational atherectomy during percutaneous. Oct 17, 2017 the management of cac in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. Combined use of rotational and excimer laser coronary. Rotational atherectomy ra is an effective way of mechanically modifying and debulking calcified coronary artery lesions. Current status of rotational atherectomy sciencedirect.
Weihsianyin ivusguided rotational atherectomy for unexpandable paclitaxeleluting stent. Reappraisal value of a modified rotational atherectomy. Rotational atherectomy an overview sciencedirect topics. Rotational atherectomy through a coronary artery bypass. Rotational atherectomy is the most commonly used atherectomy device and removes atheromatous plaque by differential cutting, that is removing the inelastic calcified plaque with microscopic 20 to 50 micrometers diamond chips embedded on the surface of a. The technique works through the method of differential cutting whereby the burr selectively abrades harder tissue and is deflected away from normal vessel wall thus removing superficial calcium and dense fibrous plaque.
Adjunctive balloon angioplasty was net used to reduce residual. Over 3 decades of clinical experience and research, techniques have matured and outcomes have improved. Jan 19, 2021 free pdf download clinical cases in coronary rotational atherectomy. It works by ablating and softening calcified plaques to enlarge the arterial lumen and enable the delivery and deployment of stents and other enabling strategies 1. These constructions are designed to tolerate delivery through tortuous vessels and can endure high speed rotation used during activation of the atherectomy treatment.
Feb 02, 2014 rotational atherectomy and platelets activation of platelets by rotablation is speeddependent transmission electron micrography. Typically 6 fr difficulty visualizing the vesselwith contrast injected through a 5 fr guide while performing rotational atherectomy with a 1. A randomized comparison of balloon angioplasty versus. Previous studies about the outcomes of ra were limited with small sample size and lowrisk population. Rotational atherectomy with new ablative strategies have been proposed for the treatment of extremely calcified lesions prior to stent implantation. Case reports a case of an entrapped rotational atherectomy. Pdf rotational atherectomy ra is an atheroablative technology that enables percutaneous coronary intervention for complex. Rotational atherectomy can be performed with high success rates and low complications, and rotational. Intravascular ultrasound ivus revealed rotational atherectomy could successfully ablate both the metallic ring and the calcified ring. Global atherectomy market incredible possibilities and forecast to 2027 the global atherectomy market was valued at usd 1. Ra works on the principle of differential cutting and preferentially ablates hard, inelastic. Patient selection and procedural considerations for coronary.
The interest in rotational atherectomy ra has increased over the past decade as a consequence of more. Nov 08, 2016 rotaxus rotational atherectomy prior to taxus stent treatment for complex native coronary artery disease, as the only randomized trial to date that tested the strategy of routine lesion preparation with ra followed by des implantation against stenting without ra, showed a higher rate of procedural success in patients undergoing ra, which. Pdf successful rotational atherectomy of midsaphenous. Intact platelet membrane, intracellular granules, and clear background.
Rotational atherectomy orbital atherectomy comments. Some operators use the dynaglide facility rotational speed 70000 rpm to. The incidence of slow flow or no reflow in the rotational atherectomy has been reported to be 6 % to 15 %, 25,26 whereas in the orbit ii trial the rate of persistent slow flowno reflow for orbital atherectomy were notably very low, occurring in 0. Pdf european expert consensus on rotational atherectomy. The evidence base examining its safety and utility is sparse and limited to small case. Ivusguided rotational atherectomy for unexpandable. As compared to other countries, ra in japan has uniquely developed with the aid of greater usage of intravascular imaging devices such as intravascular ultrasound ivus or optical coherence tomography oct.
Clinical cases in coronary rotational atherectomy springerlink. The interest in rotational atherectomy ra has increased over the past decade as a consequence of more complex and calcified coronary stenoses being attempted with percutaneous coronary interventions. To compare outcomes of bailout and planned rotational atherectomy ra in the treatment of severe calcified coronary lesions. Sep 07, 2020 once across the occlusion, we performed atherectomy with the rotarex rotational excisional atherectomy system over the included rotarex. Intensive plaque modification with rotational atherectomy and.
Rotapro rotational atherectomy system boston scientific. Directional atherectomy an overview sciencedirect topics. A new addition to the group of approved atherectomy devices is the peripheral rotablator rotational atherectomy system boston scientific corporation, natick, ma. Calcified lesion assessment and intervention in complex. Effectiveness of rotational atherectomy of right coronary artery. Ivus has been used to understand the guidewire bias and to. Highly experienced european rotablator operators developed a standardised protocol on the roleof rotational atherectomy in an era of increasingly complex, c. In the late 20th century, ra was employed regularly in percutaneous coronary intervention pci. Rotational excisional atherectomy with the rotarex. Experimental investigation of the grinding force in rotational atherectomy. Out of 82 patients, 59 patients were nooption cad patients where the patients had undergone one or two bypass graft surgeries and were unfit for another surgery. Stents implanted into hard, calcified lesions do not always fully expand, even though they are inflated at very high pressure, and once the device. Rotational atherectomy device rotablator components. Rotablator atherectomy trial also showed no benefit with aggressive strategy for procedural success or target vessel revascularization at 6 months, and indeed figure 1.
Driveshafts used in atherectomy medical devices are often comprised of coiled or braided metal wires. As has been discussed, this technique has associated risks, some unique to the device 614. Rotational atherectomy continues to be a widely used modality in interventional cardiology, especially in calci. Rotational atherectomy ra is an atheroablative technology that enables percutaneous coronary intervention for complex, calcified coronary lesions. The rotational atherectomy catheter uses a rapidly spinning abrasive tip welded to the end of a flexible metal drive shaft to grind the internal lumen of an atherosclerotic plaque. Incidence and determinants of complications in rotational. The comparison of balloonangioplasty versus rotational atherectomy study cobra is a multicentre, prospective, randomized trial to compare short and longterm effects of percutaneous transluminal coronary angioplasty ptca and. So far, reports of rotational atherectomy in vein grafts have been concerned with ostial and distal anastomotic lesions. Angiographic evidence of thrombus prior to treatment with the rotablator rotational atherectomy system. Rotational atherectomy of a lesion in which stent expansion was. The system includes the rotablator console and foot pedal, the rotalink advancer and burrs 1. The best studied rotational atherectomy device is the rotablator boston scientific, mn, usa. Rotational atherectomy was commonly used as both a standalone procedure and later as a prelude to balloon dilation for modifying coronary artery plaques. When the thrombus has been resolved for two to four weeks, the lesion may be treated with the rotablator rotational atherectomy system.
May 26, 2016 background this study investigated whether, for patients with severely calcified coronary lesions, use of a cutting balloon cb during rotational atherectomy ra before placing a drugeluting stent will improve periprocedural outcomes, compared to ra with a conventional plain balloon. Pdf experimental investigation of the grinding force in. Calcium deposits within a coronary artery are a harbinger of previous inflammation, healing, and scarring. Role of rotational atherectomy in percutaneous coronary. The invention provides a rotational atherectomy device having, in various embodiments, a flexible, elongated, rotatable drive shaft with a system of eccentric abrading heads attached thereto. Ra rotational atherectomy, ivus intravascular ultrasound, oct optical coherence tomography. Rotational atherectomy ra has been practised by cardiologists for over 30 years. Some operators use the dynaglide facility rotational speed 70 000 rpm. Total rotational procedure time should not exceed five minutes. Wo2014042752a3 rotational atherectomy device with eccentric. Methods in a randomized controlled trial, patients with severely calcified lesions of calcium arc. Apr 01, 2015 the best studied rotational atherectomy device is the rotablator boston scientific, mn, usa. Sep 28, 2016 rotational atherectomy was done in 181 patients. Rotational atherectomy ra is an alternative or adjunctive procedure to percutaneous balloon angioplasty.
Nov 17, 2020 combining rotational ra and excimer laser coronary atherectomy elcaraser atherectomy is technique utilized in the percutaneous management of calcific coronary disease. It also monitors and displays burr rotation speed and rotational atherectomy procedural time. To introduce a modified rotational atherectomy ra procedure and investigate the early and midterm outcomes of the rafacilitating diversified percutaneous coronary intervention pci in a large group of aged patients with higher cardiovascular risk. We achieved significant luminal gain after only a single pass with the rotarex device figure 4.
The risks of rotational atherectomy can be reduced if the device and associated accessories are used in the appropriate patient population by a physician who has had adequate training. In certain embodiments, the abrading heads may be at least partially hollow. Once in the guide catheter, many operators prefer manual pushing to introduce the burr. The atherectomy device debulks soft and calcified plaque while minimizing injury to adjacent normal arterial segments.
Rotational atherectomy system procedure checklist caution. Intensive plaque modification with rotational atherectomy. Rotational atherectomy should be performed only by physicians trained in percutaneous interventional procedures. A rotational atherectomy guidewire was advanced alongside our existing guidewire into the distal lad. This european expert consensus document stems from the awareness of the. Patient selection and procedural considerations for. Under the guide of intravascular ultrasound ivus, rotational atherectomy ra successfully ablated the stent layers and the protruding calcified plaque. Rotational atherectomy ra is an endovascular procedure to ablate atherosclerotic plaque by forward advancement of a rotating abrasive burr.
Case reports a case of an entrapped rotational atherectomy burr. Rotational atherectomy system gold standard rotablator therapy on an enhanced easytouse platform advancer with onoff and dynaglide controls small console with intuitive lcd display 5k and 10k rpm deceleration indicator onoff instant response button mobile cart with small gas tank for quick setup and easy portability. As it is technically demanding, rotational atherectomy is also uncommon. Cardiovascular outcomes following rotational atherectomy. Trends in utilization, and comparative safety and effectiveness of orbital and rotational atherectomy. Rotational atherectomy through a coronary artery bypass graft. Unlike angioplasty and stenting, which are designed to move plaque to the side but not get rid of it, a successful atherectomy removes the plaque from the artery and restores normal healthy blood flow. Download fulltext pdf download fulltext pdf read fulltext. The ablated segment was scaffolded with a new paclitaxeleluting stent, well expanded and documented by ivus.
If the burr has lodged in the lesion, cease rotational atherectomy and carefully attempt to. Transradial rotational atherectomy with drugeluting stents for heavily calcified lesions. Rotational atherectomy complicated by coronary perforation is. Pdf successful rotational atherectomy of midsaphenous vein. Rotational atherectomy in clinical practice circulation. What the study adds the present study included 335 rotational ather ectomy cases from the jpci registry, which is a national, prospective, multicenter registry operated by the japanese association of cardiovascular intervention and therapeutics. We explore whether same day discharge sdd is a feasible and safe practice following rotational atherectomy rota treatment during elective percutaneous coronary intervention pci, and examine which baseline characteristics are independently associated with sdd. See the full video and hundreds more detailing cardiovasc. The console may be powered by both nitrogen and compressed air. Frontiers percutaneous rotational mechanical atherectomy. Plateletrich plasma through chamber with rota burr held stationary 0 rpm and stirred in an aggregometer for 5 minutes. The interest in rotational atherectomy ra is growing in the current percutaneous coronary intervention pci, mainly because of the expansion of pci indications to more complex atherosclerotic lesions as a consequence of the improved restenosis rate after drugeluting stent evolution. Balloon angioplasty and stenting of right coronary ostial stenosis may frequently be impeded by lesion calcifica tion, whereas rotational atherectomy, which.
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