Table 2: Strategies to Prevent and Manage Complications of Rotational Atherectomy.

	Avoidance	Management
Slow flow	Small burrs and low speeds Intermittent runs Optimal antitplatelet and antithrombotic regimen Continuous flush solution	Optimise BP if low (hydration/vasopressors/IABP if needed) Use of intracoronary vasodilators, i.e. nitrates/verapamil/adenosine/nitroprusside
Dissection	Careful case selection to avoid excessive tortuosity	Avoid further RA if dissection identified Maintain wire position and perform angioplasty/stenting as for any PCI
Perforation	Commonly related to poor technique (oversizing of burr, excessive angulation, high speeds)	Standard technique for treatment of coronary perforation including cessation of anticoagulation, balloon tamponade, coil embolisation, and covered stents Emergent pericardiocentesis if tamponade
Burr entrapment	Rare with optimal technique More common with 1.25 mm burr	Pulling the RotaWire using its 0.014 inch spring tip combined with push and pull on the drive shaft Position second wire to allow balloon placement proximal to entrapped burr Deep intubation of guiding catheter or cutting the burr drive shaft with insertion of a mother-in-child catheter Subintimal tracking and reentry with balloon dilatation adjacent to the trapped burr CT surgery consultation if failure of percutaneous retrieval

IABP = intra-aortic balloon pump, PCI = percutaneous coronary intervention, RA = rotational artherectomy. Source: Barbato et al. 2015.[22] Reproduced with permission from Europa Digital & Publishing.