ROTATIONAL ATHERECTOMY - TECHNIQUE, INDIC ATION, RESULTS

Rotational atherectomy (Rotablation) represents one of the alternative devices to treat complex coronary artery stenoses. Rather than increa sing luminal diameter by arterial stretching and plaque fracture as wi th balloon angioplasty, rotablation debulks atherosclerotic plaque wit h an abrasive diamond coated bun. The basic physical principle is diff erential cutting. It allows the advancing burr to selectively cut inel astic material while elastic tissue deflects away from the bun: 95% of the particles generated by the Rotablator are less than 5 microns. Th ey are removed by the body's reticuloendothelial system. There are dif ferent strategies to perform a rotablation, regarding the number of bu rrs used and the final burr-to-artery ratio. An adjunctive PTCA is rec ommended without proof by randomized studies so far. The best indicati on for the Rotablator is the undilatable lesion. Lesion modification ( debulking) as a method of improving vessel compliance seems to be also usefull in diffusely diseased and calcified vessels, as well as in ao rto-ostial and angulated stenoses. The instent restenoses is a new ind ication. Randomized studies will have to proof if there is an advantag e for rotablation compared to PTCA. Restenosis rates appear comparable to balloon angioplasty.