Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023

Figures

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  Fig. 1. How to cut and pull the drive shaft sheath. A A RA burr (1.25 mm) was inserted into a 6 Fr guide catheter via a Y connector. B, C The drive shaft, drive shaft sheath, and RA wire were cut together near the advancer. D, E The drive shaft sheath was pulled back and removed. F After the drive shaft sheath was removed, the drive shaft remained in the same position. G, H A guide wire (0.014 inch) passed through the guide catheter via an inserter and Y-connector. I A 2.5 × 15 mm conventional balloon easily passed through the guide catheter. This figure was reproduced with the permission from Sakakura et al. [111]

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  Fig. 2. Why RA to ostial RCA is difficult?

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  Fig. 3. Schema of two types of perforation in LCX ostial lesions with substantial bending

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  Fig. 4. Schema of conventional and halfway rotational atherectomy. A–C illustrate the conventional rotational atherectomy, whereas D–F illustrate the halfway rotational atherectomy. A The burr positioned just before the calcified lesion. B The burr ablated the proximal segment of the calcified lesion. C The burr ablated the full segment of the calcified lesion. D The burr positioned just before the calcified lesion. E The burr ablated the proximal segment of the calcified lesion. F Balloon dilatation was performed for the rest of the calcified lesion. This figure was reproduced with the permission from Sakakura, et al. [141]

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  Fig. 5. Algorithm: When operators felt difficulty in RA for diffuse long calcified lesions