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