Elastic Material Damage of Rotational Atherectomy and Orbital Atherectomy: An in Vitro Assessment

Purpose: Rotational atherectomy (RA) and orbital atherectomy (OA) are effective procedures for severe calcified coronary artery disease. Nonetheless, vessel perforation remains an adverse complication of these procedures. This study aimed to evaluate factors affecting elastic material damage caused by RA and OA. Methods: An in vitro assessment was conducted in which the damage to the rubber latex, an elastic material, after RA was evaluated under various conditions, including burr rotational speed (100,000–220,000 rotations per minute), approaching curve, burr size (1.25 mm, 1.75 mm, and 2.0 mm), and fluid viscosity (water and low-molecular weight dextran). Similarly, the rubber latex damage after OA was evaluated in the same experimental system under various conditions, including crown rotational speed, approaching curve, and fluid viscosity. Results: In RA, the rubber latex was damaged at lower rotational speeds (p = 0.003), tighter approaching curves (p < 0.0001), and lower fluid viscosity (p = 0.03). In OA, the rubber latex was generally severely damaged. Conclusion: A higher rotational speed, coaxial approach for the wall, and higher viscosity contributed to lesser elastic material damage in RA. The safety mechanism for elastic material in OA proved less effective.