Rotational Atherectomy

Overview

4.5 out of 5 (2 Reviews)

Credits

1.50

Post Assessment Questions

10

Start Date

1 Jan 2021

Last Review Date

3 Jul 2023

Expiration Date

31 Dec 2023

Estimated Time To Finish

90 Minutes

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Activity Description

Coronary stenoses with circumferential or significant vessel calcification are rigid and frequently not dilatable with use of conventional balloon angioplasty. Often stent dilation and maximal vessel wall apposition are compromised in extensively calcified coronary lesions, stents deployed in heavily calcified vessels without atherectomy tend to thrombose, restenosis, and could cause stent fracture. Significant calcification remains a major limitation of balloon angioplasty as well as successful stent delivery to severely affected vessels. In cases with heavily calcified lesions, high-pressure, non-compliant balloon inflations may still fail to dilate adequately and prepare a heavily calcified vessel for stent delivery. This activity reviews the indications, contraindications, and complications of rotational atherectomy and highlights the role of the interprofessional team in the management of patients with CAD. Atherectomy refers to the removal of the obstructing material, and in our case this is calcium. By removing significant calcification or modifying the calcified atherosclerotic plaque vessel wall compliance in calcified or fibrotic lesions is increased, and the lumen diameter gained from using this device will be much improved as compared to the use of simple balloon angioplasty. Rotational atherectomy is one of several ways to perform atherectomy in a coronary vessel. It is the most commonly used atherectomy device and removes atheromatous plaque by differential cutting, that is removing the inelastic calcified plaque with microscopic (20 to 50 micrometers) diamond chips embedded on the surface of a rapidly rotating (150,000 to 200,000 rpm) olive-shaped burr. Such abrasion generates 2 to 5-micrometer microparticles that propagate through the coronary microcirculation and are removed by the reticuloendothelial system. The burr travels over a specialized 0.009-inch guidewire and is available in diameters ranging from 1.25 to 2.50 mm. In the setting of severe calcification, smaller burr sizes should be used initially, followed by larger burrs in 0.25 to 0.50-mm increments up to 70% of the reference vessel diameter. This activity describes rotational atherectomy, and explains the role of the interprofessional team in managing patients who undergo this procedure.

Target Audience

This activity has been designed to meet the educational needs of physicians.

Learning Objectives

At the conclusion of this activity, the learner will be better able to:

  • Describe the technique of rotational atherectomy.
  • Review the indications for rotational atherectomy.
  • Summarize the complications of rotational athetectomy.
  • Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients undergoing rotational atherectomy.

Disclosures

The Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they or their immediate family may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by CUSOM for resolution, to ensure fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

CUSOM will identify, review, and resolve all conflicts of interest that faculty, authors, activity directors, planners, managers, peer reviewers, or relevant staff disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Disclosure information for authors, editors, planners, peer reviewers, and/or relevant staff is provided with this activity.

Continuing Education Accreditation Information

 

 

The Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. CUSOM designates this enduring material for a maximum of 1.50 AOA Category 1 B Credits and will report CME credits commensurate with the extent of the physician's participation in the activity.

Cancellation Policy: Cancellations must be received in writing and a money back guarantee is provided if not completely satisfied.

  • StatPearls and CUSOM reserve the right to cancel any course due to unforeseen circumstances. StatPearls and CUSOM will not be responsible for other expenses incurred by the participant in the unlikely event that the program is canceled.

Equal Opportunity

  • StatPearls and CUSOM are Equal Opportunity / Affirmative Action / Equal Access Institutions. 

Medium or Media Used:

  • Computer Requirements:  Internet Access
  • E-mail Address

Instructions for Credit

  1. Register for the activity and create a StatPearls login.     
  2. Review the required accreditation information:  Target audience, learning objectives and disclosure information.
  3. Complete the entire self-study activity.
  4. Complete the post-test assessments.
  5. Successfully pass the post-test with a minimum score of 100%.
  6. Complete the evaluation form.
  7. Obtain a certificate.

StatPearls and CUSOM adheres to AOA Standards regarding commercial support of continuing medical education. It is the policy of StatPearls and Campbell that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved and also that authors and editors will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation. Detailed disclosure will be made prior to starting the activity.

The information provided at this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

This course is intended for osteopathic physicians who wish to earn AOA CME credit. Take this version of the course to ensure you receive appropriate credit.

 

 
 

Reviews

Maureen W. on 2/5/2023

julian j. on 2/20/2024

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