Acute angiographic and clinical outcome of high speed percutaneous rotational atherectomy (rotablator®)

Abstract

Percutaneous rotational atherectomy (Rotablator®), a high speed (>100,000 RPM) rotational burr, was used successfully in 38 of 43 patients (88%) (mean age: 65 ± 7 years) with 82 lesions (71 stenoses and 11 occlusions). The clinical indications were claudication (84%), nonhealing ulcer (7%), and renovascular hypertension (7%). Rotablation was successful in 78 of 82 lesions (95%): 68 of 71 (96%) stenoses (12 of 12 iliac, 11 of 11 femoral, 7 of 8 popliteal, 36 of 37 tibial, and 2 of 3 renal arteries; 60% of lesions were diffuse, i.e., >/4 cm in length), and 10 of 11 (91%) occlusions (5 of 6 femoral, 1 of 1 popliteal, 3 of 3 tibioperoneal, 1 of 1 brachial artery). The Rotablator significantly (p<0.001) reduced the arterial obstruction (stenoses: 85 ± 11% to 12 ± 12%); occlusions: (100% to 25 ± 10%). The effective final burr size for arteries varied at 3.5–4.5 mm for renal, 3.0–3.5 mm for femmoral, and 2.0–3.0 mm for brachial and tibial. Complications included gross hemoglo‐binuria without sequelae in 27 patients (63%), groin hematoma in 10 (23%), arterial spasm in 10 (23%), and arterial bypass in 2 (5%). The Rotablator® was successfully used, without concomitant conventional balloon angioplasty, to open arterial lesions with excellent angiographic results in both diffuse and segmental peripheral vascular disease. There was gratifying patient clinical improvement.