What are contraindications for rotablator use?

• A. Thrombus-filled lesions and SVGs due to risk of distal embolization
• B. Noncalcified soft plaques with good flow
• C. Lesions in small distal vessels under 2 mm
• D. Allergic reaction to contrast only

Answer: (A)

Rotational atherectomy relies on a high-speed burr to ablate calcium in a lesion, but this process can dislodge debris or thrombus and send it downstream, risking distal embolization and no-reflow. That risk is why thrombus-filled lesions are a clear contraindication, and why lesions in saphenous vein grafts are treated with extra caution or avoided when possible. The other scenarios aren’t absolute contraindications: noncalcified soft plaques with good flow aren’t targets for this device and can be managed withOther strategies; small distal vessels under 2 mm present technical and safety challenges but aren’t universally disqualifying; and contrast allergy, while a consideration, isn’t a true contraindication because precautions or alternative imaging/preparation can allow procedure if needed.