Rationale for the association of rotational atherectomy and drug‐eluting stents

Percutaneous coronary interventions (PCIs) are standard therapy for the treatment of atherosclerotic lesions of the coronary arteries. Since the introduction of rotational atherectomy (RA) in 1989, it has become established as a necessary adjunct to PCI in a small proportion of cases, notably calcified lesions. However, its use is hampered by the recurrent phenomenon of restenosis. The introduction of stent technology (first bare-metal stents and, subsequently, drug-eluting stents) promised a solution to this problem. The most appropriate combination of angioplasty and stent after RA remains controversial. We review results obtained with RA alone, and in combination with angioplasty and/or bare metal or drug-eluting stents, with a view to identifying the most appropriate choice of stent after RA in coronary artery lesions.