Chapter 34: Transradial Rotational Ablation

The use of rotational atherectomy for plaque modification in de novo complex calcified or fibrocalcific lesions began more than 30 years ago. Invented by David Auth in 1981 and approved for coronary use in 1993, it was introduced in the same era as intravascular ultrasound and coronary stents. It continues to be available for selective cases and is an effective adjunctive procedure when paired with angioplasty and drug-eluting stents.

The use of rotational atherectomy technology via the transradial approach is no different than through femoral access. However, its initial use requires training. The Rotablator® Didactic Program provides technique and safety information for using the Rotablator® Peripheral Atherectomy System (Boston Scientific).

The current indication for the Rotablator is plaque modification for heavily calcified or fibrocalcific lesions to allow better positioning and stenting. It works via the principle of differential cutting or selective ablation of a fibrocalcific lesion—the rotating burr cuts through the lesion (the noncompliant tissue is ablated) but the normal elastic tissue is deflected away. Due to the fact that the lesion must permit crossing with the Rotawire™ (Boston Scientific), it is not used for chronic total occlusions (CTOs). The complete Rotablator Rotational Atherectomy System, the console, guide catheters, burrs and RotaGlide™ Lubricant (Boston Scientific), are needed for this technique.

Ramon Quesada, MD, FACP, FACC, FCCP, FSAI