Rotational atherectomy uses the principle of high-speed abrasive differential cutting to ablate atheromatous plaque. This system, developed by David Auth, was approved for coronary use in 1993. Rotational atherectomy and other newer devices were designed principally to aid in the procedural success of percutaneous coronary intervention and potentially to reduce the occurrence of restenosis compared with that achieved with balloon angioplasty. Obviously, none of the newer devices (except for stents) have reduced the rates of restenosis, but rotational atherectomy may indeed be useful in certain lesion subsets in clinical practice. This chapter discusses the principles of operation, system and design characteristics, relevant clinical data, technical and procedural issues, and management of complications associated with rotational atherectomy.
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