2. Rotablation in RC
Hospital Frankfurt since
1992
1st 2nd, 3rd procedure
with David Auth
1994: 20% of PTCA
= about 1200/y
Jan 1996 Meeting at
Stanford
5. CONCLUSIONS ERBAC
(ROTABLATOR VS LASER VS BALLOON):
Procedural success superior to Laser and
balloon
Late outcomes: more restenosis than
balloon
Plaque debulking before balloon dilatation
improves success, but is not helpful to
improve longterm results
6. Failed CTO: the facts
• Balloonfailure 2-15% reason for failure (1)
• 7% fail after GW crossing (2)
• Tornus successful in 91% (3)
• Rotablator successful in 95.5% (4)
1)Stone 2005 ; ERCTO 2007 2) Pagnotta 2010
3) Reifart 2008 4)Pagnotta 2010
21. ERCTO 2014-17: Rotablator
• 2014 - 2017 n = 373 / 14198 (2.7%)
• 79/209 (38%) Registry Operators use
Rotablator (46/75 (61%) full members)
22. Rotablator vs. no
• Age 69.3 64.2 **
• Diabetes 39% 30.3% ***
• Okkl.length 26.4 mm 29 mm n.s.
• Calcium sev. 67.2% 14.0% ***
• Post CABG 28.1% 12.1% ***
23. Rotablator vs no
• Success 93.7% 86.9% ***
Proc. Time 133 min 99 min ***
• Fluoro 53.2 min 42.4 min ***
• AK 2707 mGy 2463 mGy **
• DAP 12404 cGy/qcm 10672 **
• Dye 250 ml 255 ml n.s.
24. Rotablator vs no
• MACE 4.95% 5.1% n.s.
• MI 0.52% 0.51% n.s.
• Perforation 3.4% 3.2% n.s.
25. Summary
• About 3% of all CTO cases might
fail because a balloon does not
follow the wire or expand well
• Rotablator is used in 2.7% of all
CTO cases by < 50% of the
operators
• Success 94% MACE 5%
26. Downside
• Double edged decision because you need to
pull the 0.014 CTO wire
• 30% longer procedural time and 25% more
radiation
• Not easy to learn (penetration only 40%)
27. Study-Drawback
• Prospective but selfreporting registry,
monitoring 10% only
• Success not comparable to „no Rotablator“:
Only „wired“ cases
• Some operators might use Rotablator for
debulking highly calcifyed crossable lesions
and not as bailout only (included in
analysis)
28. I Cannot immagine doing CTO
or other complex cases
wo. backup of Rotablator
29.
30. Reasons for failed CTO-PCI
EuroCTO Club 2006
(n=1659 CTO by16 operators)
• Wire did not cross (89%)
• Balloon did not cross (4%)
• Stent could not be placed (2%)
• Severe complication (0.5 %)
• Other (e.g fatigue, limit of dye, no flow)
(4.5%)
