Author + information
- Nauman Siddiqi,
- Sandeep Kumar,
- Judith Raqueno and
- John Wang
Rotational atherectomy therapy with the Rotablator system (Boston Scientific, Marlborough, MA) has evolved over time. It was first introduced in the 1990s as a stand alone intervention for complex coronary artery disease. It would later become an adjunct to coronary stenting. As its role became more complimentary, many aspects of the procedure changed, improving procedural outcome. However, one of the fundamental components of the procedure has remained nearly unchanged– the Rotablator “cocktail.” This typically consists of the Rotaglide solution (Boston Scientific, Marlborough, MA), heparin, nitroglycerin, calcium channel blockers, and/or adenosine; in an effort to prevent slow-flow or no-reflow phenomenon. Since adopting modern procedural techniques at our institution, we have routinely used heparin alone in the cocktail, significantly simplifying the pharmacological preparation time. Therefore a retrospective case series was constructed to show the safety and feasibility of routine heparin-only Rotablator cocktail.
A registry of all Rotablator cases performed at our institution was created. The study design was a retrospective case series. Inclusion criteria were all cases involving Rotablator therapy from January 2007 through May 2015. Primary outcome was incidence of no-reflow or slow-flow post rotational atherectomy. Secondary outcomes included procedural success and total procedure time. Exclusion criteria included the addition of Rotaglide, nitroglycerin, calcium channel blockers, or adenosine in the Rotablator flush bag.
A total of 96 Rotablator cases were indentified for the time period of January 2007 through May 2015 where only heparin was used in the cocktail. Rotational atherectomy was successfully performed in 91 cases (94.8%). The Rotablator burr would not cross for 5 cases. Of the successful cases, slow-flow or no-reflow occurred in 2 cases (2.2%). Total procedure time for successful cases was 82 minutes and 12 seconds per case.
The simplified Rotablator cocktail may serve to compliment the modern procedural techniques such as smaller burr/artery ratios, single burr approach, lower rotational speeds, and shorter ablation run times. Combining these procedural techniques with the routine use of a heparin-only cocktail was safe with low rates of slow-flow or no-reflow (2.2%); and high rates of procedural success (94.8%). This study is limited by its retrospective nature and small sample size but warrants further prospective randomized data.