Complications of Rotablation
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.
KeywordsRotational atherectomy Burr entrapment RotaWire™ fracture
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