RCA with massive calcifications

Protocol

• OptiRAY® (Ioversol)
• Concentration 350 mgI/ml
• Flow rate: 8 mL/ s
• Volume: 228 mL
• Total exposure : 8.2 Gy
• Exposure time: 62 minutes
• 15 images / slow dose Philips

Learning points

• Lesions selection for Rotational atherectomy.
• How to prepare  and use the device.
• Guiding catheter, guidewire  and Burr size selection.
• How to perform multilevel plaque modification.
• Guiding catheter extension to improve support and stent delivery.
• IVUS assessment before and after stenting.

Step-by-Step Procedure

• Arterial Femoral access 7F, Temporary pace-maker insertion and RCA catheterization with JR4 7F Guiding catheter.
• Crossing the lesion using Whisper LS coronary PCI guidewire.
• Exchange the Coronary guidewire with Rotawire Extra support guidewire using a Finecross microcatheter.
• Rotational atherectomy runs from proximal RCA to the distal bifurcation with 1.5mm Burr.
• IVUS assessment showing optimal plaque modification.
• Predilatation with 3.0x20mm balloon and Rotawire exchange to BMW 0.014 guidewire.
• Stenting of the distal bifurcation with 4.5x18mm Onyx Drug Eluting Stent using Guideliner catheter extension.
• Stenting of the distal PL with 3.5x12mm Onyx stent for dissection.
• Stenting of the Mid and Proximal RCA .
• IVUS control of the final result.

Biobliography

• European expert consensus on rotational atherectomy - Article 
  Authors Emanuele Barbato Adam de Belder

• Current Status of Rotational Atherectomy - Article
  Authors Matthew I. Tomey, Annapoorna S. Kini and Samin K. Sharma
  Publication DOI: 10.1016/j.jcin.2013.12.196
   
• Utility of rotational atherectomy and outcomes over an eight-year period. - Article
  Authors Couper LT Shaw JA
  Publication 2015 Oct;86(4):626-31. doi: 10.1002/ccd.26077.
   
• Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients.- Article
  Authors Warth DC; Buchbinder M
  Publication 1994 Sep;24(3):641-8.

• Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS). -  Article
  Authors Whitlow PL Feldman T.
  Publication 2001 Mar 15;87(6):699-705
   
• Clinical Characteristics and Long-Term Outcomes of Rotational Atherectomy　- J2T Multicenter Registry. - Article
  Authors Okai I  Daida H
  Publication Circ J. 2018 Jan 25;82(2):369-375. doi: 10.1253/circj.CJ-17-0668. Epub 2017 Sep 21.

• ROTABLATOR System Didactic training – online Website
  Authors Boston Scientific