Which are indications for rotablator use?

• A. Soft plaque that responds to POBA
• B. Extremely calcified lesions that don't respond to POBA or CTO
• C. Venous graft stenosis
• D. Acute vessel rupture

Answer: (B)

Rotational atherectomy is used when the lesion is extremely calcified and remains undilatable after conventional balloon angioplasty. The fast-rotating burr preferentially ablates hard calcium, thinning and modifying the plaque so the lumen can be adequately enlarged with ballooning or stenting. This makes it particularly helpful in lesions that either cannot be crossed or cannot be effectively dilated by plain balloon angioplasty, including calcified chronic total occlusions.

Soft plaques dilate well with POBA, so rotablation isn’t typically beneficial there. Venous graft stenosis is usually treated with standard balloon or stent therapy, not rotablation. Acute vessel rupture is a dangerous scenario where rotablation would be inappropriate; the rupture is managed emergently with balloon tamponade and often covered stents.