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ROTABLATOR TRICKS AND TIPS AND HOW TO TREAT COMPLI Kaiser Southbay Interventional Cardiology CATION ~;'-\ KAISER PERMANENTE Historical Use of Atherectomy Devices DCA • • 3.25-4.0mm vessels • 2.75-3.5mm vessels • Ostial lesions • Bifurcations • Long, diffuse disease • Instent restenosis • Superficial calcium Soft, eccentric plaque • Bulky, proximal lesions • Ostial lesions • Bifurcations • Rotablator • 2.5-3.25mm vessels • Calcified lesions • Long-diffuse disease • In-stent restenosis TEC n >3.75mm vessels r:; n Thrombus n SVGs •, -·~ •m'1 Kaiser Southbay Interventional Cardiology KAISER PERMANENTE.,, ROTABLATOR MYTHS CANNOT TREAT THROMBOTIC LESIONS DO NOT BURR DISSECTIONS OR AFTER BALLOONING ROTA CTO’S ONLY AFTER IVUS TO CONFIRM TRUE LUMEN ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology What Is Your Greatest Fear ? ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology OSTIAL RCA LESIONS RECALCITRANT LESION REFLECTIONG DISEASE OF AORTIC WALL HIGH RATE OF ISR ATTEMPTS WITH DOUBLE LAYER STENTS UNSUCCESSFUL ~;'-\ KAISER Kaiser Southbay Interventional Cardiology PERMANENTE USE OF CUTTING BALLOON ASSOCIATED WITH AORTIC DISSECTION HYDRAULIC DISSECTION FROM INJECTION INTO FLEXTOME CUT DISSECTION LESS 10 WILL CAN BE TREATED MEDICALLY IF CM ~;'-\ KAISER Kaiser Southbay Interventional Cardiology PERMANENTE HEART RHYTHM HR SLOWING RESOLVES WITH CONTINUED ROTABLATION STAFF DETERMINES TOLERANCE FOR NOT FOR OSTIAL RIGHT LESIONS USING PACERS TEMPORARY PACER PACER CAN BE ASSOCIATED WITH TAMPONADE IN ERA OF 2b3a AGENTS ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology PHARMACOLOGIC REGIMEN ATROPINE WHEN PLATFORMING COMPLETED URINARY RETENTION IN MALES AMINOPHYLLINE 5MG/KG TREAT ADENOSINE BOLUS RELATED RESPONSE ~;'-\ KAISER Kaiser Southbay Interventional Cardiology PERMANENTE aiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE DETACHED BURR ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology LMCA TO OSTIAL/PROXIMAL CIRCUMFLEX LESIONS ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology 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 ASSOCIATED WITH CONCERNS THAT CAN CAN BE BE AVOIDED OR TREATED EASILY ~;'-\ KAISER PERMANENTE Kaiser Southbay Interventional Cardiology ... SVGs •, -·~ •m'1 Kaiser Southbay Interventional Cardiology KAISER PERMANENTE.,, ROTABLATOR MYTHS CANNOT TREAT THROMBOTIC LESIONS DO NOT BURR DISSECTIONS OR AFTER BALLOONING ROTA CTO’S ONLY AFTER... AORTIC DISSECTION HYDRAULIC DISSECTION FROM INJECTION INTO FLEXTOME CUT DISSECTION LESS 10 WILL CAN BE TREATED MEDICALLY IF CM ~;'- KAISER Kaiser Southbay Interventional Cardiology PERMANENTE... STAFF DETERMINES TOLERANCE FOR NOT FOR OSTIAL RIGHT LESIONS USING PACERS TEMPORARY PACER PACER CAN BE ASSOCIATED WITH TAMPONADE IN ERA OF 2b3a AGENTS ~;'- KAISER PERMANENTE Kaiser Southbay Interventional