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ROTABLATOR TRICKS AND TIPS AND HOW TO TREAT COMPLICATIONS Kaiser Southbay Interventional Cardiology... Kaiser Southbay Interventional Cardiology ROTABLATOR MYTHS CANNOT TREAT THROMBOTIC

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ROTABLATOR

TRICKS AND TIPS

AND HOW TO TREAT COMPLICATIONS

Kaiser Southbay Interventional Cardiology

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Historical Use of Atherectomy Devices

• Soft, eccentric plaque

• Bulky, proximal lesions

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ROTABLATOR MYTHS

CANNOT TREAT THROMBOTIC LESIONS

DO NOT BURR DISSECTIONS OR AFTER

BALLOONING ROTA CTO’S ONLY AFTER IVUS TO CONFIRM TRUE LUMEN

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What Is Your Greatest Fear ?

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OSTIAL RCA LESIONS

RECALCITRANT LESION REFLECTIONG DISEASE

OF AORTIC WALL HIGH RATE OF ISR

ATTEMPTS WITH DOUBLE LAYER STENTS

UNSUCCESSFUL

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USE OF CUTTING BALLOON ASSOCIATED WITH

AORTIC DISSECTION HYDRAULIC DISSECTION FROM INJECTION INTO

FLEXTOME CUT DISSECTION WILL CAN BE TREATED MEDICALLY IF

LESS 10 CM

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HEART RHYTHM

HR SLOWING RESOLVES WITH CONTINUED

ROTABLATION STAFF DETERMINES TOLERANCE FOR NOT USING

PACERS TEMPORARY PACER FOR OSTIAL RIGHT LESIONS

PACER CAN BE ASSOCIATED WITH TAMPONADE

IN ERA OF 2b3a AGENTS

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PHARMACOLOGIC REGIMEN

ATROPINE WHEN PLATFORMING COMPLETED

URINARY RETENTION IN MALES

AMINOPHYLLINE 5MG/KG BOLUS

TREAT ADENOSINE RELATED RESPONSE

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CHALLENGE OF THE DISTAL LESION

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CHALLENGE OF DISTAL LESIONS

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WIRE SUPPORT CATHETHERS WILL NOT ALWAYS

CROSS COMPLEX LESIONS CAN TRY TO DILATE WITH SMALL BALLOONS

REMOVE CROSSING WIRE WITH DOTTERING MOTION

AND IMMEDIATELY PASS ROTAWIRE FLOPPY MAY BE BETTER THAN EXTRA SUPPORT FOR ADVANCING

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ADVANCE BURR AS FAR DISTAL AS POSSIBLE

MOVE ADVANCER BURR BACKWARD WHILE

ADVANCING THE ROTABLATOR SHEATH BURR WILL JUMP BACKWARDS WHEN YOU START

SPINNING THE BURR WILL NOW GO FURTHER DISTALLY

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LMCA LESIONS

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LEFT MAIN INTERVENTIONS

DOUBLE KISS MINICRUSH IS STRATEGY OF

CHOICE

BIFURCATION STENTING IS ASSOCIATED

WITH HIGHR ISR

CAN PLACQUE MODIFICATION INCREASE FINAL

MLD, REDUCE PACQUE SHIFT OR AVOID BIFURCATION STENTING

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LMCA LESION

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STENT LMCA INTO CX

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PLACQUE SHIFT

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TYPICAL COMPLEX MVD

LMCA INTERVENTION

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IMMEDIATELY TAMPONADE WITH OTW BALLOON

NO PERFUSION BALLOONS IN THE US

PROLONGED INFLATIONS 10 MINUTES?

CHEST PAIN, PRESSURE, ST ELEVATION SEDATE PATIENT AND STAFF

REVERSE HEPARIN WITH PROTAMINE?

COVERED STENTS

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SIGNS OF TAMPONADE

HYPOTENSION

“HALO” SIGN

RESPIRTORY VARIATION “PULSUS”

ELEVATED AND EQULIZED RIGHT PRESSURES

RA.RVED,PAD,AND PCW DECREASED OPACIFICATION CORONARY SINUS

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PERICARDIOCENRESIS

ECHO SUBXIPHOID VIEW

ATTACH V1 ELECTRODE TO NEEDLE

ASPIRATE WHILE ADVANCING AND WATCH EKG FOR ST ELEVATION

ADVANCE WIRE UNDER FLUORO

WATCH FOR PERICARDIAL LOOP

SMALL DILATOR WITH CONTRAST INJECTION ADVANCE PIGTAIL WHILE REMOVING WIRE

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ROTABLATOR GREATEST FEARS

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NO FLOW

IV VASOPRESORS

DO NO IMPEDE IN FLOW WITH GUIDING

CATHETHER OTW BALLOON IN TREATED AREA

INFUSE CORONARY CAPILLARY MEDICATIONS VERPRAMIL, CARDENE, ADENOSINE, NIPRIDE

IF CONTINUED DECREASD FLOW, INFLATE

BALLOON, REMOVE WIRE, INJECT CORONARY MEDICATIONS

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BURR EXTRACTION

DETACH BURR FROM ADVANCER

SECOND GUIDE WITH LUBRICIOUS

FOR TRAPPED BURR, MOVE ADVANCER BACK

WHILE ADVANCING ROTAWIRE

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TRAPPED BURR

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DETACHED BURR

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FINAL THOUGHTS

ROTABLATOR IS SAFE

PLANNED ROTATIONAL ATHERECTOMY IS SAFE AND MORE

EFFICIENT

COMPLICATIONS CAN OCCUR AND NOT SIGNIFICANTLY DIFFERENT

FROM COMPLICATIONS IN THIS ERA OF COMPLEX INTERVENTIONS AND CTO’S

TREATMENT WITH ROTATIONAL ATHERECTOMY CAN BE

ASSOCIATED WITH CONCERNS THAT CAN BE AVOIDED OR TREATED EASILY

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