Alternative Rota-Flush Solution for Patients With Severe Coronary Artery Calcification who Undergo Rotational Atherectomy

Abstract

We assessed the feasibility and safety of a rota-flush solution with 10,000 U of unfractionated heparin in 1 L of normal saline in patients who underwent rotational atherectomy. Background. Rotational atherectomy with the Rotablator (Boston Scientific) rotational atherectomy system is an effective way to modify severely calcified plaque. Potential complications include coronary spasm and slow-flow/no-flow. A pressured rota-flush solution is infused into the device to lubricate the drive shaft to minimize the risk of these complications as well as facilitate delivery of the device. RotaGlide lubricant (Boston Scientific), which decreases the friction between the drive shaft and RotaWire (Boston Scientific), is routinely added to the rota-flush solution. Antispasmotic agents including nitroglycerin and verapamil are commonly added to the rota-flush solution, but can lead to hemodynamic disturbances like hypotension and bradycardia. Methods. A total of 67 consecutive patients who underwent rotational atherectomy from July 2012 to June 2015 were included in this analysis. The primary endpoint was procedural success. Results. Procedural success was achieved in all patients. Significant hypotension occurred in 6%. No patients developed severe bradycardia requiring emergent insertion of a transvenous pacemaker. Major adverse cardiac and cerebral events occurred in 6.0%, all due to non-fatal myocardial infarction. Slow/no flow occurred in 7%, with subsequent resolution after intracoronary vasodilator therapy. Coronary spasm occurred in 4%. Stent thrombosis, perforation, flow-limiting dissection, and stent loss were not observed. Conclusion. A rota-flush solution with 10,000 U of unfractionated heparin in 1 L of normal saline is a reasonable alternative to the routinely used solution which includes the RotaGlide lubricant, nitroglycerin, and verapamil.