Figure 1.1
RotaWire floppy (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
Figure 1.2
RotaWire stiff (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
The WireClip torquer has two clips that allow the torquer to open longitudinally, following which the wire is mounted and gripped from the side (Fig. 1.3). It allows some torquing of the wire and helps prevent spinning of the guidewire when the brake is released. It can also be positioned in the docking port of the advancer in order to release the brake allowing a smooth pullback of the burr (Fig. 1.4).
Figure 1.3
WireClip torquer (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
Figure 1.4
WireClip torquer docking port (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
Rotaburr
The burr is elliptical shaped and nickel coated. The proximal surface is smooth, while the distal edge is coated with 2,000–3,000 microscopic diamond crystals. The diamond crystals are 20 microns, with 5 microns exposed on the surface. The diamond coating is present only in the front half of the elliptical burr and absent at the back (Fig. 1.5). Therefore, the ablation can only occur during antegrade movement. It also means that when a burr is trapped distal to lesion, it will not be able to burr backwards. The sizes of the burr are shown in Table 1.1.
Figure 1.5
Rotaburr (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
Table 1.1
Burr sizes and guide requirements
Burr diameter (mm) | Recommended guide catheter (French) | Minimum guide internal diameter required (in.) |
|---|---|---|
1.25 | 6.0 | 0.060 |
1.50 | 6.0 | 0.063 |
1.75 | 7.0 | 0.073 |
2.00 | 8.0 | 0.083 |
2.15 | 8.0 | 0.089 |
2.25 | 9.0 | 0.093 |
2.38 | 9.0 | 0.098 |
2.50 | 9.0 | 0.102 |
Foot Pedal
The foot pedal consists of two main components (Fig. 1.6). Stepping on the main pedal allows flow of high-pressure nitrogen through the system activating the burr. Beside the main pedal is the DynaGlide switch, which activates the DynaGlide, allowing retrieval of the burr at lower rotational speeds of 60,000–90,000 rpm.
Figure 1.6
Foot pedal (Image provided courtesy of Boston Scientific. © 2017 Boston Scientific Corporation or its affiliates. All rights reserved)
Rotablator Console
There are several monitors on the main console (Fig. 1.7) – the rotational speed display on the right of the console, the procedure timer in the middle and the pressure gauge on the left. There is a knob to adjust the rotational speed as well as an indicator for DynaGlide activation. It should be noted that the burr speed can decrease when in contact with vessel wall or with the lesion; therefore, the operator must increase the rotational speed knob in order to ensure that the burr is advancing at the desired revolutions per minute.
