Solution Landscape
Table 1. Complications of common atherectomy tools.
Rotablator
The Rotablator uses rotational technology to differentially ablate the hard calcified plaque while leaving the more pliant vessel wall intact. However, this is not always the case as the Rotablator still causes perforations and dissections 5% to 8% of the time. These adverse events usually result when trying to ablate lesions located along tortuous parts of the vessel.
In these cases, when the Rotablator is delivered to the site of the lesion, the lesion's morphology will push the burr into the vessel wall. Thus, as the burr ablates the lesion, it will also ablate the layers of the vessel.
Diamondback 360
The Diamondback 360 is similar to the Rotablator in that it also uses a diamond coated crown to differentially sand the calcified plaque. However, instead of a rotational motion concentric to the center of the burr, the Diamondback 360 revolves about the center of the wire. The radius of the revolutions can be incrementally increased by increasing the speed of the revolutions. While this design does allow for increased blood flow during ablation, it suffers from high dissection and perforation rates due to the difficulty in controlling the ablation surface as it ricochets off the plaque within the artery.