Which of the following is a contraindication for Rotablator use?

• A. Thrombus-filled lesions
• B. Smooth, nonocclusive lesions
• C. Noncalcified plaques
• D. Prior grafts with good flow

Answer: (A)

Thrombus inside the coronary lesion is the main reason Rotablator use is contraindicated. The Rotablator relies on a high-speed burr to sand away calcified, hardened plaque, creating a smoother lumen for balloon dilation and stent delivery. When a thrombus is present, the rotating burr can disrupt the clot and propel clot fragments downstream, causing distal embolization and microvascular obstruction. This increases the risk of slow flow or no-reflow, myocardial injury, and unstable hemodynamics, making the procedure hazardous.

Smooth, nonocclusive lesions and noncalcified plaques aren’t the typical targets for this device and don’t carry the same embolic risk from thrombus disruption, though they may be less ideal indications. Prior grafts with good flow aren’t inherently contraindicated either. The key contraindication to grasp here is thrombus-filled lesions due to the dangerous downstream consequences of thrombus disruption by the burr.