In addition to calcified lesions unresponsive to POBA, rotablator is indicated for which lesion type?

• A. Chronic total occlusions (CTO)
• B. Acute vessel rupture only
• C. Non-atherosclerotic lesions
• D. Venous graft stenosis only

Answer: (A)

Rotational atherectomy is used to modify hard calcified plaque that resists balloon dilation, allowing better balloon expansion and device delivery for stenting. Chronic total occlusions are a scenario where this calcified plaque can prevent crossing and effective dilation, so using the rotablator to debulk or modify the calcified occlusion can facilitate subsequent ballooning and stenting. This makes CTOs a classic additional indication beyond calcified lesions that don’t respond to POBA.

Acute vessel rupture, non-atherosclerotic lesions, and venous graft stenosis are not typical primary targets for rotational atherectomy. Rupture requires hemostasis and vessels’ mechanical support; non-atherosclerotic disease often lacks the calcified substrate rotablation needs; venous graft disease is usually managed with ballooning or stenting unless there is heavy calcification where other strategies are preferred.