What is a key intra-procedural issue to monitor when using the Rotablator?

• A. Dissection or distal embolization if burr is advanced too quickly
• B. Drop in rpm of about 5,000
• C. Balloon rupture risk
• D. Vasospasm due to contrast

Answer: (A)

In rotational atherectomy, the most important intra-procedural issue is controlling burr advancement to prevent vessel injury and downstream debris from causing problems. If the burr is pushed through a calcified lesion too quickly, it can disrupt the plaque and intima, leading to dissection and distal embolization of calcific debris. The safe approach is slow, incremental passes with a gentle pecking technique, watching for resistance and signs of burr stall, and adjusting rather than forcing progression. This focus on controlled advancement is why dissection or distal embolization is the best answer. While monitoring burr speed or other factors is important, they do not define the principal intra-procedural risk in the same way.