St raub Medical´s ROTAR E X ® t h ro m b e c to my d ev i ce

u sed as an atherectomy d ev i ce i n re ca n a l i za t i o n
of chroni c calcified SFA– P O P o cc l u s i o n s

A . Peer, A. Altshuler
U nit of Inter ventional Radiolo g y A ssa f H a rofe h M e d i ca l Ce n te r I s ra e l

In the past 4 years we have been using
the ROTAREX as an atherectomy device for
®
recanalization of chronic, at times heavily
calcified, occlusions of the SFA – POP seg-
ments.
Procedures were performed either from
the contra-lateral (the majority) or ipsi-
lateral approaches. The 6 F device was the
standard with only 2 cases in which the 8 F
device was used.
Our technique was to use a sheath (Flexor/
Cook) 1 F larger than the ROTAREX device.
®
This enabled us to routinely flush the treat-
ed segment with heparinized saline with-
out the need to remove the ROTAREX and ®
thus prevent over-heating and blockage of
the rotating head.
In all 40 cases performed we had never
seen any distal embolization, which in our
opinion is due to the extraordinary power-
ful removal features of the device.
Since a 6 F device was used (creating a
2 mm channel) in all cases, PTA (5/6 mm)
was performed with additional stenting
when necessary. In very heavily calcified
segments it was at times difficult to ope-
rate the ROTAREX® so repeated passes were
used and in few cases 2 mm PTA was per-
formed of the isolated segment in order to
enable the ROTAREX® to remove the plaque.
In our opinion the ROTAREX® device is both
safe and very effective as an atherectomy
device when treating occlusions of the SFA
– POP segments. Heavily calcified lesions
are, in our opinion, not contra–indications
for using the ROTAREX®, though the proce-
dure takes more time and needs additional
PTAs to overcome the calcifications.
Case 1:
A 80 yrs old male with severe c h ro n i c PV D a n d rest p a i n .

Figure 1 Figure 2 Figure 3

Figure 1+2:
Selective right leg angio (contra-lateral
approach) showing marked narrowing
of SFA origin combined with total occlu-
sion of the artery at mid point. Distal
POP is visualized via DFA collaterals.

Figure 3:
After crossing the occlusion, atherecto-
my was performed with a 6 F Rotarex.
Mild calcifications of the SFA are seen.

Figure 4:
Figure 4 Figure 5 Figure 6 Post-atherectomy recanalization of the
SFA-POP segment was achieved.

Figure 5:
PTA with a 6 mm balloon was performed.

Figure 6:
Final result showing a good flow in the
SFA-POP has been established.
Case 2:
A 75 yrs old female with know n c h ro n i c PV D w h i c h g ot wo rse

d u ring the last weeks with seve re rest p a i n .

Figure 1 Figure 2
Figure 1:
Angio of the left leg showing occlusion
of the proximal POP from the Hunter Ca-
nal with large collateral vessel bypas-
sing the occlusion. Multiple atheroma-
tous plaques were seen in the SFA.

Figure 2:
After crossing the lesion, atherectomy
with a 6 F Rotarex was performed.

Figure 3:
Post-atherectomy recanalization was
Figure 3 Figure 4 achieved with mark stenosis of the
Popliteal artery which was then treated
by 6 mm PTA (not shown).

Figure 4:
Final angio showing good recanali-
zation of the treated segments.
Case 3:
A 75 yrs old male with chron i c b i l a te ra l PV D wa s a d m i tte d d u e to

severe rest pain and non-hea l i n g fo ot u l ce r.

Figure 1 Figure 2 Figure 3
Figure 1:
On angio of his left leg, a total occlusi-
on of the distal POP is seen. No vascu-
lar history of recent thrombo-embolic
event was known.

Figure 2:
Atherectomy with a 6 F Rotarex of both
distal POP and Tibio-Peroneal segments
was performed.

Figure 3:
Post Rotarex, residual stenosis is seen
Figure 4 Figure 5 Figure 6 in the recanalized segment.

Figure 4:
5 mm PTA of the stenosis.

Figure 5:
Final result with good patency of the
treated segment.

Figure 6:
Angio one year post atherectomy show-
ing good flow with only minimal narro-
wing of the treated segment. (Patient
was admitted for treatment of his right
leg).