Orbital and Rotational Atherectomy,Cutting and Scoring BalloonAngioplasty, and Laser Flashcards
What is the Rotablator system?
An over the wire system with a nickel-plated, diamond-coated brass burr driven by compressed gas, achieving speeds up to 200,000 rpm.
The burr creates microparticulate debris when in contact with inelastic tissue.
What are the sizes of diamond chips on the Rotablator burr?
20- to 30-μm-sized diamond chips located only on the front half of the burr.
The burr is olive-shaped.
What is the primary use of the Rotablator in the present era?
To treat complex coronary artery lesions including lesions >20 mm, calcified lesions, and ostial and bifurcation disease.
Its use has declined with the advent of drug-eluting stents.
What were the findings of the STRATAS and DART trials regarding rotational atherectomy?
Neither trial found a lower incidence of restenosis with rotational atherectomy compared to balloon angioplasty.
STRATAS trial (2001) and DART trial (2003) examined restenosis rates in randomized fashion.
What is the indication for using rotational atherectomy according to the 2011 ACC/AHA guidelines?
Indicated for use in nondilatable lesions as debulking prior to stent placement.
Further attempts at predilation would be unhelpful.
What is the excimer laser coronary atherectomy system (ELCA)?
A system consisting of a multifiber catheter and a CVX-300 console that emits light at ultraviolet wavelengths of 308 nm.
It vaporizes plaque using photochemical, photomechanical, and photothermal effects.
What is the role of the AngioSculpt scoring balloon?
A balloon catheter with three rectangular nitinol scoring wires wrapped in a helical fashion, allowing greater focal force compared to standard balloons.
It minimizes slippage in restenotic lesions.
What is wire bias in the context of rotational atherectomy?
The position of the rotational atherectomy wire in an eccentric position within the coronary vessel.
It can facilitate effectiveness if positioned against the lesion.
What is the mechanism of action of orbital atherectomy?
It utilizes centrifugal force to press a diamond-coated crown against the lesion, resulting in differential sanding.
It is an over the wire system with a single eccentrically mounted crown.
What are the potential complications associated with laser angioplasty?
Increased incidence of perforation and local complications due to scattering of laser light by contrast.
Coaxial guidewire positioning is important for success.
What is the primary indication for orbital atherectomy?
Treatment of heavily calcified lesions.
It is particularly suited for lesion preparation prior to stenting.
True or False: Rotational atherectomy reduces restenosis rates before the use of drug-eluting stents.
False.
The ROTAXUS trial indicated similar late lumen loss with or without rotational atherectomy.
What is the difference in particle size generated by orbital atherectomy compared to rotational atherectomy?
Particles generated during orbital atherectomy are <2 μm, while those from rotational atherectomy are 5 to 12 μm.
Smaller particles are believed to be less likely to cause microvascular plugging.
Fill in the blank: The Flextome Cutting Balloon Device features _______ longitudinally fixed to a balloon.
atherotomes.
Atherotomes create controlled longitudinal incisions when deployed.
What is the maximum pressure that the AngioSculpt scoring balloon can be expanded to?
20 atm.
This allows greater force to be applied compared to standard balloon angioplasty.
What is a clinical contraindication for using a cutting balloon distal to a recently implanted stent?
Fear of having the atherotomes entangled with the stent on withdrawal.
This could lead to complications during the procedure.
What is the primary indication for the use of orbital atherectomy?
Treatment of heavily calcified lesions
Orbital atherectomy is specifically designed for addressing severe calcification in coronary arteries.
How do the particles generated by orbital atherectomy compare to those generated by rotational atherectomy in terms of size?
Orbital atherectomy generates particles smaller than 2 μm, while rotational atherectomy generates particles between 5 to 12 μm
Smaller particles from orbital atherectomy are believed to have different biological effects.
What is a contraindication for the use of orbital atherectomy?
Presence of angiographically visible thrombus
This condition increases the risk of distal embolization and potential slow or no reflow.
What strategies can prevent slow flow during rotational atherectomy?
Strategies include:
* Lower burr speeds
* Short runs <45 to 60 seconds
* Applying Rotaglide lubricant
* Aggressive vasodilation with nitroglycerin or nitroprusside
* Maintenance of blood pressure with short acting pressors
These strategies help mitigate the risk of microvascular obstruction.
True or False: Routine use of rotational atherectomy has been shown to improve outcomes for de novo or restenotic lesions.
False
It has a class III indication for this purpose, indicating it is not recommended.
What complication may arise from excessive forward pressure on the burr during ablation?
Type III, free-flowing perforation at the lesion site
This can occur if ablation penetrates too deeply into the vessel wall.
What is recommended regarding the positioning of the guidewire for orbital atherectomy?
The guidewire should be positioned at least 10 cm distal to the lesion
This ensures proper navigation and effectiveness of the procedure.
Fill in the blank: Orbital atherectomy is delivered over a _______ guidewire.
0.012-in. guidewire
This is specific to orbital atherectomy, while rotational atherectomy uses a 0.009-in. guidewire.
What is a common reason for failure to obtain stent expansion despite high-pressure balloon angioplasty?
Calcific constraint of the stent
Rotational atherectomy may be necessary to address the calcification before stent expansion can occur.
What are the results of the ORBIT I trial regarding device success?
Device success was 98%
The ORBIT I trial was a two-center prospective nonrandomized feasibility study.
What percentage of patients experienced major adverse events in the ORBIT I trial?
4% in-hospital, 6% at 30 days, and 8% at 6 months
These figures reflect the safety profile of orbital atherectomy.
What was the rate of slow flow and no reflow after orbital atherectomy in the ORBIT II trial?
Less than 1%
This demonstrates the effectiveness of orbital atherectomy in minimizing these complications.
What alternative treatment might be considered if rotational or orbital atherectomy fails?
CABG (Coronary Artery Bypass Grafting)
This is a surgical option when other interventions are unsuccessful.
