ROTABLATOR

Components
 Console
 Burr
 Drive shaft
 Turbine
 CONSOLE-is a reusable part of the system which controls the
rotational speed of the drive shaft and burr
 BURR-NICKEL PLATED BRASS BURR, elliptical in shape.
 coated with diamond chips that are between 20 & 30 micro in

size.
 burr is bounded to a drive shaft

 Drive shaft-flexible, housed in a 4.3Fr Teflon
sheath , connected to a turbine
 Turbine-driven by compressed air or nitrogen
and rotates the shaft and burr at speeds of

150,000 to 200,000 rpm.
 Turbine is activated by a foot pedal and
controlled by the console

Indications
 The target lesion is in a native vessel
 The target lesion is undilatable by a balloon due to

calcium or fibrosis.
 The target lesion is an ostial lesion .
 The target lesion is located at a bifurcation and

debulking is required to reduce the risk of plaque
shift .
 The target lesion could not be crossed with the

primary device .
CONTRA INDICATIONS
 Ejection fraction < 30%
 Shock or hypotension
 The target lesion is the sole remaining conduit
 Severe angulation at the target lesion
 The lesion is in a saphenous vein graft
 Angiographic evidence of thrombus

Contraindications
 Occlusions through which a guide wire will not pass.
 Last remaining vessel with compromised left

ventricular function.
 Angiographic evidence of thrombus prior to treatment

with the Rotablator System.
 Angiographic evidence of significant dissection at the

treatment site.
Burrs and guidewires
 Burrs for use in the coronary arteries are available
in -1.25,1.5,1.75,2.0,2.15,2.25,2.38,2.5mm sizes
 8Fr for 1.25 to 2.15.
 9Fr for 2.25,2.38.
 10Fr for 2.5mm burr.
 Inner diameter of the guide catheter must be

0.004”> the burr size.
Guidewires:
ROTA WIRE FLOPPY-
-diameter of the distal 44cm - tapers from 0.009” to 0.007” to 0.005 “
-2.2cm long platinum tip
-soft tip
-0.014 “ diameter tip
-325cm in length
-long, tapered shaft
-shaft maximizes flexibility
ROTA WIRE EXTRA SUPPORT-
-diameter of the distal 5cm tapers from 0.009 “to 0.005 “
-2.8cm long platinum tip
-soft tip
-0.014” diameter tip
-325cm in length
-short, tapered shaft increases vessel straightening
ROTA WIRE FLOPPY GOLD-
-gold coated distal tip provides excellent radiopacity
-increases visibility aids in anticipating the path of the rotablator burr
-long tapered shaft maximizes flexibility and minimizes unfavorable guide
wire bias
Physical principles and
design
Two principles that enable rotablator to ablate
atherosclerotic plaque are:
1.Differential cutting-
is the ability of a device to selectively cut one
material while maintaining the integrity of another,
based on differences in substrate composition.
2.Orthogonal displacement of friction-
explains the easy passage of the burr through
tortuous and diseased segments of the coronary
vasculature.
Adjunctive medication
 Aspirin is mandatory
 Adequate hydration and CCB also recommended-to
reduce the frequency of vasospasm
 During the procedure-heparin -to maintain
ACT>350sec throughout the case
 GP IIb/IIIa inhibitors
 Intracoronary verapamil and diltiazem –helpful in
reversing slow flow or no reflow
 Sometime cocktail of NTG,Verapamil and heparin-
reduce the incidence of no-reflow
Technique
GUIDE CATHETER SELECTION AND
GUIDE WIRE PLACEMENT :
 Internal diameter of the guiding catheter
must be 0.004inch larger than the burr

 1.25mm to 2.15mm burr advanced through
8F guide
 2.25mm and 2.38mm burr-9F guide
 2.5mm burr -10F guide

Burr selection and placement
 A two-burr approach, beginning with a burr-to-
artery ratio of 0.5-0.6 and ending with a burr-to-
artery ratio of 0.75-0.8
 Initiating treatment with a burr to artery ratio <0.5 is
usually reserved for total occlusion lesions, severe
bends, lesions > 30mm in length
 After the burr is tested outside the body, it is
advanced to a position just proximal to the target
lesion
 If the burr is activated while in contact with the
arterial wall the risk of vessel injury is greatly
increased
The burr is advanced till just
proximal to the stenosis.
There after saline flush is infused,
rotation is initiated.
Rotating burr is gently advanced
through the lesion.

ABLATION TECHNIQUE
 Most imp principle of this technique is the use of
RPM surveillance to guide slow and careful
advancement of the burr through the lesion
 Aggressive burr advancement, indicated by
excessive deceleration, increases the risk of vessel
trauma and ischemic complications caused by heat.
 Intermittent contrast injections should be
performed to provide visual assessment of burr
advancement-injections identify borders of the
lesion and orientation of the device in tortuous
segments and the burr to artery relationship
Adjunctive treatment
 Most burrs are small in relation to the target
vessel, adjunctive PTCA is required to achieve
definitive lumen enlargement in over 90% of
lesions
 In general most of the lumen enlargement
occurs after PTCA

 Many pts are now being treated with rotablator
and stents-rotastents in complex lesions

(calcified lesions, long lesions, diffuse disease)
Complications
 Death in 1%
 Q wave MI in 1.2%
 Emergency CABG in 2.5%
 Non-Q wave MI in 6.8%
 Angiographic complications included
dissection 10-13%
 Slow-flow 1.2-7.6%
 Perforation 0-1.5%
 Severe spasm 1.6-6.6%

Restenosis
 Restenosis rates were
lowest for short calcified lesions-6.3%
and highest for non-calcified lesions >20mm
in length 37.2%

In late revascularization (22% for
PTCA vs. 18% after rotablator) or
angiographic restenosis (48% for PTCA vs.
52% for rotablator)
Summary:
FFR measurement (1/2)
1. Verification of equal signals when sensor is just outside the guiding

catheter opening.
2. Advance wire, sensor crosses lesion.
3. Induce maximum hyperemia and measure FFR.
4. Because sensor is 3 cm from tip,easily pull-back and push-up for exact

spatial information.
If desirable, perform a pull-back recording.
2007 Radi Medical Systems AB 60713 Rev 01 2007-06

Summary
FFR measurement (2/2):
5. PCI if indicated, with possibility for Pw (wedge) measurement for

collateral flow assessment.
6. Followed by FFR measurement to check result.

If desired, perform hyperemic pull-back recording.
7. Verify absence of drift at the end of procedure, or between measurements

in several vessels.
2007 Radi Medical Systems AB 60713 Rev 01 2007-06

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Components

 BURR-NICKEL PLATED BRASS BURR, elliptical in shape.

 coated with diamond chips that are between 20 & 30 micro in

 burr is bounded to a drive shaft

and rotates the shaft and burr at speeds of

controlled by the console

 The target lesion is undilatable by a balloon due to

 The target lesion is an ostial lesion .

 The target lesion is located at a bifurcation and

 The target lesion could not be crossed with the

 The target lesion is the sole remaining conduit

 Severe angulation at the target lesion

 The lesion is in a saphenous vein graft

 Angiographic evidence of thrombus

 Occlusions through which a guide wire will not pass.

 Last remaining vessel with compromised left

 Angiographic evidence of thrombus prior to treatment

 Angiographic evidence of significant dissection at the

 8Fr for 1.25 to 2.15.

 9Fr for 2.25,2.38.

 10Fr for 2.5mm burr.

 Inner diameter of the guide catheter must be

must be 0.004inch larger than the burr

 2.5mm burr -10F guide

through the lesion.

occurs after PTCA

and stents-rotastents in complex lesions

 Emergency CABG in 2.5%

 Non-Q wave MI in 6.8%

 Angiographic complications included

 Severe spasm 1.6-6.6%

1. Verification of equal signals when sensor is just outside the guiding

2. Advance wire, sensor crosses lesion.

3. Induce maximum hyperemia and measure FFR.

4. Because sensor is 3 cm from tip,easily pull-back and push-up for exact

2007 Radi Medical Systems AB 60713 Rev 01 2007-06

5. PCI if indicated, with possibility for Pw (wedge) measurement for

6. Followed by FFR measurement to check result.

7. Verify absence of drift at the end of procedure, or between measurements

2007 Radi Medical Systems AB 60713 Rev 01 2007-06

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