Percutaneous coronary rotational atherectomy: does it make sense in 2018?

Publication date: Available online 26 February 2018 Source:Journal of Indian College of Cardiology Author(s): Debabrata Dash Percutaneous coronary intervention (PCI) for obstructive coronary artery disease has evolved significantly since Andreas Gruentzig performed first PCI using a plain balloon catheter in Zurich in 1977. Heavily calcified coronary lesions (HCCL) pose great technical challenges for the interventionists and are associated with a high frequency of restenosis and target lesion revascularization. Sometimes HCCL can not be crossed with even the smallest available low profile balloons. They also may resist dilatation even at the highest possible balloon pressure or may cause rupture of the balloons at low inflation pressure. Furthermore, stent delivery to the HCCL may be difficult and stent expansion remains suboptimal. Percutaneous coronary rotational atherectomy (PTCRA) was developed in the late 1980s as a debulking device used to facilitate plaque removal. Compared to arterial stretching and plaque fracture as seen in PCI, PTCRA increases the luminal diameter by debulking atherosclerotic plaques with the aid of an abrasive diamond-coated burr. It was presented as a novel modality to create uniform smooth lumen with less barotrauma to the artery in the hope of reducing restenosis which was not corroborated by the trials. The initial tide of enthusiasm was then supplanted by the significant decrease in the rate of utilization of this procedure. Since drug-elu...
Source: Journal of Indian College of Cardiology - Category: Cardiology Source Type: research