Rotational Atherectomy in Clinical Practice

I would be really concerned about the cutting blades nicking the arterial walls and causing damage, leading to clots being thrown off into the brain. But I have no medical training and thus can't comment on dangers with this. Will your doctor guarantee that the <10 µm particle size will not cause a stroke?
http://circinterventions.ahajournals.org/content/9/11/e004571.extract?etoc

Goran Stankovic and Dejan Milasinovic

http://dx.doi.org/10.1161/CIRCINTERVENTIONS.116.004571

Circulation: Cardiovascular Interventions. 2016;9:e004571

Originally published November 8, 2016

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• Editorials
• complications
• coronary atherectomy
• drug-eluting stent
• plaque modification
• rotational atherectomy

Unlike balloon dilation that results in the displacement of atherosclerotic plaque with multiple intimal tears, rotational atherectomy (RA) is based on the principle of differential cutting that allows for physical removal of inelastic atherosclerotic material while rendering the inner lumen surface smooth.¹ Although plaque reduction by pulverization of atherosclerotic material into <10 µm particles has remained its central paradigm,² the conceptual framework has shifted from the original approach of RA as a debulking strategy and, thus, applicable in a broad array of coronary lesions with large plaque burden, to a contemporary selective clinical utilization, with an emphasis mainly on plaque modification prior to stent implantation.^3,4 This transition in conceptual understanding of the targeted effects of RA has been mirrored by a decreasing tendency in its use, from 20% in the mid 1990s to 1% to 3% according to contemporary reports.^4,5 Today, RA is used selectively, mainly to disrupt the continuity of the calcium ring within the vessel wall and, thus, facilitate optimal drug-eluting stent (DES) implantation in patients with severely calcified de novo coronary lesions. ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease), as the only randomized trial to date that tested the strategy of routine lesion preparation with RA followed by DES implantation against stenting without RA, showed a higher rate of procedural success in patients undergoing RA, which, however, did not translate in long-term clinical benefit.⁶ These findings coincided with previous nonrandomized studies that had also supported RA …

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