Complications of Rotablation

  • Sean M. Gallagher
  • Daniel A. Jones
  • Elliot J. Smith
Chapter

Abstract

Rotational atherectomy (RA) facilitates percutaneous coronary intervention (PCI) of severely calcified coronary lesions. RA is a technically demanding procedure associated with more complications than standard balloon angioplasty and stenting. Meticulous technique is the key to minimizing complications of RA. Optimal technique involves a gentle pecking motion to and from the lesion with an appropriately sized burr at high rotational speed, short ablation runs of no more than 20 s, and avoidance of burr deceleration. Despite these measures complications of RA will continue to occur due to the complexity of the coronary lesions treated with the technique.

Most complications of RA are common to all PCI procedures, such as peri-procedural myocardial infarction, stroke, vascular access complications, coronary dissection, abrupt vessel closure and perforation. However, there are complications solely due to the RA procedure such as slow flow/no reflow, bradycardia and atrioventricular block, or specific to the Rotablator System such as burr entrapment and RotaWire fracture. It is important that all RA operators understand these RA specific complications, and have a thorough knowledge of how to appropriately manage these complications should they occur.

Keywords

Rotational atherectomy Burr entrapment RotaWire fracture 

References

  1. 1.
    Alfonso F, Macaya C, Goicolea J, Hernandez R, Segovia J, Zamorano J, Banuelos C, Zarco P. Determinants of coronary compliance in patients with coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol. 1994;23:879–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Fitzgerald PJ. Lesion composition impacts size and symmetry of stent expansion: initial report from the strut registry. J Am Coll Cardiol. 1995;25:49A.CrossRefGoogle Scholar
  3. 3.
    Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol. 1997;29:6–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Abdel-Wahab M, Baev R, Dieker P, Kassner G, Khattab A, Toelg R, Sulimov D, Geist V, Richardt G. Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions. Catheter Cardiovasc Interv. 2013;81:285–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Tran T, Brown M, Lasala J. An evidence-based approach to the use of rotational and directional coronary atherectomy in the era of drug-eluting stents: when does it make sense? Catheter Cardiovasc Interv. 2008;72:650–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Abdel-Wahab M, Richardt G, Joachim Buttner H, Toelg R, Geist V, Meinertz T, Schofer J, King L, Neumann F, Khattab A. High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv. 2013;6:10–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Benezet J, Díaz de la Llera LS, Cubero JM, Villa M, Fernandez-Quero M, Sanchez-Gonzalez A. Drug-eluting stents following rotational atherectomy for heavily calcified coronary lesions: long-term clinical outcomes. J Invasive Cardiol. 2011;23:28–32.PubMedGoogle Scholar
  8. 8.
    Furuichi S, Sangiorgi G, Godino C, Airoldi F, Montorfano M, Chieffo A, Michev I, Carlino M, Colombo A. Rotational atherectomy followed by drug-eluting stent implantation in calcified coronary lesions. EuroIntervention. 2009;5:370–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Garcia De Lara J, Pinar E, Ramon Gimeno J, Hurtado J, Lacunza J, Valdesuso R, Valdes Chavarri M. Percutaneous coronary intervention in heavily calcified lesions using rotational atherectomy and paclitaxel-eluting stents: outcomes at one year. Rev Esp Cardiol. 2010;63:107–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Naito R, Sakakura K, Wada H, Funayama H, Sugawara Y, Kubo N, Ako J, Momomura S. Comparison of long-term clinical outcomes between sirolimus-eluting stents and paclitaxel-eluting stents following rotational atherectomy. Int Heart J. 2012;53:149–53.CrossRefPubMedGoogle Scholar
  11. 11.
    Rathore S, Matsuo H, Terashima M, Kinoshita Y, Kimura M, Tsuchikane E, Nasu K, Ehara M, Asakura Y, Katoh O, Suzuki T. Rotational atherectomy for fibro-calcific coronary artery disease in drug eluting stent era: procedural outcomes and angiographic follow-up results. Catheter Cardiovasc Interv. 2010;75:919–27.PubMedGoogle Scholar
  12. 12.
    Vaquerizo B, Serra A, Miranda F, Triano J, Sierra G, Delgado G, Puentes A, Mojal S, Brugera J. Aggressive plaque modification with rotational atherectomy and/or cutting balloon before drug-eluting stent implantation for the treatment of calcified coronary lesions. J Interv Cardiol. 2010;23:240–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Whitlow P, Bass T, Kipperman R, Sharaf B, Ho K, Cutlip D, et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). Am J Cardiol. 2001;87:699–705.CrossRefPubMedGoogle Scholar
  14. 14.
    Tomey M, Kini A, Sharma S. Current status of rotational atherectomy. JACC Cardiovasc Interv. 2014;7:345–53.CrossRefPubMedGoogle Scholar
  15. 15.
    Safian R, Feldman T, Muller D, Mason D, Schreiber T, Haik B, et al. Coronary angioplasty and rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial. Catheter Cardiovasc Interv. 2001;53:213–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Doyle B, Ting H, Bell M, Lennon R, Mathew V, Singh M, et al. Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv. 2008;1:202–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Eggebrecht H, Oldenburg O, Dirsch O, Haude M, Baumgart D, Welge D, et al. Potential embolization by atherosclerotic debris dislodged from aortic wall during cardiac catheterization: histological and clinical findings in 7,621 patients. Catheter Cardiovasc Interv. 2000;49:389–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Hoffman S, Routledge H, Lennon R, Mustafa M, Rihal C, Gersh B, et al. Procedural factors associated with percutaneous coronary intervention-related ischemic stroke. JACC Cardiovasc Interv. 2012;5:200–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Watt J, Oldroyd K. Radial versus femoral approach for high-speed rotational atherectomy. Catheter Cardiovasc Interv. 2009;74:550–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Feldman D, Swaminathan R, Kaltenbach L, Baklanov D, Kim L, Wong S, et al. Adoption of radial access and comparison of outcomes to femoral access in percutaneous coronary intervention: an updated report from the national cardiovascular data registry (2007–2012). Circulation. 2013;127:2295–306.CrossRefPubMedGoogle Scholar
  21. 21.
    Kini A, Reich D, Marmur J, Mitre C, Sharma S. Reduction in periprocedural enzyme elevation by abciximab after rotational atherectomy of type B2 lesions: results of the Rota ReoPro randomized trial. Am Heart J. 2001;142:965–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Sulimov D, Abdel-Wahab M, Toelg R, Kassner G, Geist V, Richardt G. Stuck rotablator: the nightmare of rotational atherectomy. EuroIntervention. 2013;9:251–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Hyogo M, Inoue N, Nakamura R, Tokura T, Matsuo A, Inoue K, et al. Usefulness of conquest guidewire for retrieval of an entrapped rotablator burr. Catheter Cardiovasc Interv. 2004;63:469–72.CrossRefPubMedGoogle Scholar
  24. 24.
    Cunnington M, Egred M. GuideLiner, a child-in-a-mother catheter for successful retrieval of an entrapped rotablator burr. Catheter Cardiovasc Interv. 2012;79:271–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Kimura M, Shiraishi J, Kohno Y. Successful retrieval of an entrapped rotablator burr using 5 Fr guiding catheter. Catheter Cardiovasc Interv. 2011;78:558–64.CrossRefPubMedGoogle Scholar
  26. 26.
    Sakakura K, Ako J, Momomura S. Successful removal of an entrapped rotablation burr by extracting drive shaft sheath followed by balloon dilatation. Catheter Cardiovasc Interv. 2011;78:567–70.CrossRefPubMedGoogle Scholar
  27. 27.
    Prasan A, Patel M, Pitney M, Jepson N. Disassembly of a rotablator: getting out of a trap. Catheter Cardiovasc Interv. 2003;59:463–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Foster-Smith K, Garratt K, Holmes DJ. Guidewire transection during rotational coronary atherectomy due to guide catheter dislodgement and wire kinking. Cathet Cardiovasc Diagn. 1995;35:224–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Gavlick K, Blankenship J. Snare retrieval of the distal tip of a fractured rotational atherectomy guidewire: roping the steer by its horns. J Invasive Cardiol. 2005;17:E55–8.PubMedGoogle Scholar
  30. 30.
    Mizuguchi Y, Yamada T, Takahashi A. Migration of a broken rotawire across the aorta during retrieval using the twin guidewire method. Cath Lab Digest. 2013;21(2):30–2.Google Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Sean M. Gallagher
    • 1
  • Daniel A. Jones
    • 2
  • Elliot J. Smith
    • 3
  1. 1.Interventional Cardiology SpR, Department of CardiologyBarts Heart Centre, St Bartholomews HospitalLondonUK
  2. 2.Department of Cardiology, NIHR Academic Clinical Lecturer and Interventional Cardiology SpRBarts Heart Centre, St BartholomewsLondonUK
  3. 3.Department of Interventional CardiologyBarts Heart Centre, St. Bartholomews HospitalLondonUK

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