IVUS Guided Rota & PCI to LED with LCX

Indications for Rotational Atherectomy (Rotablation)

Rotational atherectomy, also known as rotablation, is an advanced plaque-modifying technique used during percutaneous coronary intervention (PCI). It is especially helpful in treating coronary artery lesions with extensive calcification, where routine balloon angioplasty and stent deployment may be ineffective or unsafe.

The primary purpose of rotablation is to alter rigid calcium within the coronary arteries, improving vessel compliance and enabling successful balloon expansion and optimal stent placement.

Primary Indications for Rotablation

Rotablation is considered in patients with complex coronary lesions where heavy calcification interferes with standard interventional techniques. The most common indications include:

• Severely calcified coronary lesions, identified on coronary angiography or confirmed using intravascular imaging modalities such as IVUS or OCT.
• Balloon-undilatable lesions, where the balloon fails to expand adequately despite high-pressure inflation
• Failure of stent delivery, caused by rigid calcified plaques preventing stent advancement
• Lesion preparation prior to drug-eluting stent (DES) implantation, to ensure proper stent expansion and apposition

Clinical and Anatomical Situations Where Rotablation Is Preferred

Certain patient characteristics and lesion locations increase the likelihood of requiring rotational atherectomy. These include:

• Elderly patients with long-standing and diffuse coronary calcification
• Calcified ostial lesions, which are difficult to dilate using conventional balloon angioplasty
• Heavily calcified lesions in major epicardial vessels, such as the left anterior descending artery (LAD) and right coronary artery (RCA)
• Selected cases of calcified left main coronary artery disease, performed in experienced, high-volume interventional centers

Role of Imaging in Decision-Making

Intravascular imaging plays an important role in selecting appropriate cases for rotablation. Techniques such as IVUS and OCT help assess calcium thickness, circumferential involvement, and lesion length, allowing interventional cardiologists to plan the procedure more accurately.