Rotathon-series of successful Rota cases last 2 months: An audit

S. Aravindakumar

Chief consultant and interventional cardiologist, Kauvery Heart city Hospital, Trichy

Background

Physical removal of plaque and reduction in plaque rigidity facilitating dilation.

1. Rotablader ablates plaque using a;

  1. Diamond encrusted elliptical burr
  2. Rotated at high speed ( 140,000 to 180,000 rpm)
  3. By a helical driveshaft
  4. That advances gradually across a lesion over a guidewire.

2. Burr preferentially ablates

  1. Hard, inelastic material, such as calcified plaque,
  2. That is less able to stretch away from the advancing burr than healthy arterial wall
  3. This is referred to as ‘differential cutting’.

Principals

  1. RA particulate must traverse coronary microvasculature before clearance by the RES
  2. Microvascular obstruction can cause reduced contractility in myocardium slow flow/no reflow, and MI
  3. Most particles are small enough to readily pass; 98% are <10 mm, with  a mean diameter to 5 mm (smaller than normal mature erythrocytes)
  4. Thermal injury may contribute to increased risk of periprocrdural myocardial infraction (MI) and restonsis associated with excessive deceleration
  5. Modern technique, favoring gradual, intermittent ablation with a peclking motion, and slower RPMs (140,000 – 150,000) aims to minimize deceleration and thermal injury.

Indications

  1. Heavily calcified lesions (HCCL) – localized or extended
  2. Presence of circumfrential calcium ring where the lesions undilatable with balloon angioplasty
  3. Ostial lesions with severe fibrosis with or without calcification
  4. Balloon inacessiable lesion, provided that the rotawire can cross the lesion
  5. Failed PCI is either due to inability to cross the lesion or dilate
  6. Bifurcation lesions
  7. CTO inability to cross with a ballon catheter.

Contraindications

  1. Occlusion through which guidewire will not pass
  2. Last remaining vessel with compromised LV function
  3. Coronary dissections
  4. Evidence of thrombus
  5. Severe tortuosity
  6. Relatively contraindicated in vein grafts (increased risk of dissection and distal embolization).

Rotablator

Rotablator-12024-01-06-12:49:12pm
Rotablator-22024-01-06-12:49:55pm

Case presentation

Case 1

Kannan admitted with a chief complaints of,

  1. Unstable Angina, DM+
  2. HN
  3. Plan Fix Lad First/Rca-Rota

Angiographic Results

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Optimal MSA confirmation through IVUS

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Final Result

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Case 2

A 70 year old male patient Krishnamoorthy wiith a chief complaint of

  1. DM+, HT
  2. Lesion LM to MID LAD

Final Result

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Excellent Angiographic Results

Discussion

Total cases – 8

  1. Male – 8
  2. Female – 0
  3. Youngest – 60
  4. Oldest – 78
  5. Average age – 71

Procedures

  1. Lmca – 2
  2. Lad – 5
  3. Rca – 1
  4. Multivessel pci – 2
  5. Only rota – 0

LV dysfunction

  1. Severe – 3
  2. Moderate – 2
  3. Mild -1
  4. Normal – 2
  5. Mortality – 0

Route of procedure

  1. Femoral

Additional support

  1. IVL – 1
  2. Cutting balloon – 4

Imaging guidance

  1. Average length of rotablation 38mm (22-60)
  2. Inotropic support – 2

Hospital stay

  1. ICU stay 1 day – 8
  2. Ward stay 1day – 6
  3. Ward stay 2 days – 2

Conclusion

  1. Rotablation is a complex high risk procedure
  2. Infrequently performed
  3. More common in males
  4. Long standing cad with multiple risk factors
  5. Common in lad
  6. Good preparation and good teamwork results in good outcome
  7. No variation in hospital stay
  8. Higher cost
  9. Imaging guidance for better outcomes.
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Dr. S. Aravinda Kumar

Chief consultant and Interventional cardiologist

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