Rotational Atherectomy — EECC MCQ

Correct answer: E — RA uses a diamond-tipped burr rotating at 140,000-180,000 rpm to selectively ablate hard calcified plaque (differential cutting) while deflecting soft tissue; indicated when calcification prevents balloon expansion, stent delivery, or adequate stent expansion

Rotational atherectomy (RA, Rotablation) uses a diamond-encrusted elliptical burr that rotates at high speed (140,000-180,000 rpm), exploiting the principle of differential cutting — the hard, inelastic calcified plaque is ablated into microparticles (<5 microns), while normal elastic vessel wall deflects away from the burr. Indications per the 2024 ESC CCS Guidelines: (1) severely calcified lesions preventing balloon crossing or expansion; (2) undilatable stenoses (balloon cannot expand despite high-pressure inflation); (3) as preparation for adequate stent expansion in calcified lesions. RA is typically followed by balloon angioplasty and DES implantation. Key technical points: burr:artery ratio ≤0.7 to avoid complications; pecking motion; liberal use of flush cocktail (heparin + GTN + verapamil). Complications include slow flow, perforation, and burr entrapment.

Reference: ESC (2024): CCS Guidelines