Rotational atherectomy

Since 1979, plain old balloon angioplasty (POBA) has provided relief of angina for many patients. Recurrent symptoms due to restenosis diminished with bare-metal stent and, more recently, drug-eluting technology. A limitation to achieving good results with POBA and stenting is calcification within the artery which not only can prevent passage of balloons and stents into a lesion but also may prevent adequate lumen expansion. Rotational atherectomy or rotablation (RA) can treat highly resistant calcified plaque within coronary arteries to allow adequate vessel expansion and ensure optimal stent deployment. The concept of using a high-speed diamond-tipped drill spinning at 150 000rpm driven by compressed air to clear an artery that is 3mm in diameter is challenging, yet this technique has been available for use in coronary arteries since 1989 when M.E. Bertrand (Lille, France) and R. Erbel (Essen, Germany) first used it in humans.