Novel Technique of Advancing the Rotational Atherectomy Device: "Single-Operator" Technique

OBJECTIVE: We report the clinical outcomes of the "single-operator" technique, whereby the operator both advances the rotational atherectomy (RA) device and keeps the distal wire in place. BACKGROUND: Severely calcified lesions are associated with increased ischemic complications during percutaneous coronary intervention. RA, which utilizes a differential cutting mechanism of action for plaque modification, is a valuable treatment option for patients with severely calcified vessels prior to stent implantation. Reasons that may explain the underutilization include lack of operator experience and the availability of a skilled assistant to maintain wire position while the operator advances the device to the lesion. Loss of wire position can lead to increased procedural and fluoroscopic times. METHODS: In a prospective single-center study, a total of 67 consecutive patients underwent RA from July 2012 to June 2015. The primary endpoint was successful delivery of the RA device to the lesion without losing wire position with procedural success. RESULTS: The primary endpoint was met in 100% of the patients. The 30-day major adverse cardiac and cerebrovascular event rate was 6.0%, all due to non-fatal myocardial infarction. There was no cardiac death, target lesion revascularization, stroke, stent thrombosis, perforation, or flow-limiting dissection. Five patients had slow flow, but resolved with intracoronary vasodilator therapy and achieved TIMI grade 3 flow. CONCLUSION: RA can be performed successfully without a skilled assistant to maintain wire position during advancement of the burr, and the absence of an assistant should therefore not eliminate the performance of RA.