Difference Between Low‐Speed and High‐Speed Rotational Atherectomy Using Two Types of Guidewires

BACKGROUND: Debulking devices are necessary to treat severe calcified lesions. Rotational atherectomy (RA) is widely employed to modify calcified plaques, but the influence of procedural variables, such as guidewire type and ablation speed, on ablation outcomes is not well established. AIMS: This study aimed to evaluate the effect of guidewire type and rotational speed on ablation performance during RA using an in vitro simulation system using HEARTROID system® and optical coherence tomography (OCT). METHODS: Using the HEARTROID® cardiac simulator, twenty calcified lesions in a mid-left anterior descending (LAD) artery model were ablated. Two types of RotaWire-floppy and extra-support-were tested at high (190,000 rpm) and low (140,000 rpm) speeds. Pre- and post-ablation OCT were performed to evaluate lumen area, directional discrepancy between pre-OCT or guidewire position and actual ablation direction, and the size of debulked regions. RESULTS: A total of 171 debulked cross-sections were analyzed. In floppy wire groups, high-speed RA was associated with significantly greater directional discrepancy compared to low-speed RA. Conversely, in extra-support wire groups, high-speed RA resulted in significantly smaller directional discrepancy than low-speed RA. Debulked area tended to be larger at low speed for floppy wire and at high speed for extra-support wire, though differences were not statistically significant. The combination of extra-support wire and high-speed ablation produced the most predictable and controlled debulking. CONCLUSIONS: Guidewire type and rotational speed significantly influence directional control during RA. High-speed ablation with an extra-support wire minimizes directional discrepancy and may allow more predictable and controlled lesion modification.