rotablation.

But we have to keep in mind what our goal of rotation atherectomy is for each individual lesion.

Is it simply to provide a channel to get a balloon across and to deliver balloon-based therapies, in which case a small burr is almost certainly the treat of choice? Or is it in a case like this where we've got large nodular calcification encroaching on the lumen of the vessel, do we want to provide some debulking of that lesion? In which case, a slightly larger rotabur would be preferable.

So in this case, a slightly larger rotabur was chosen to provide some debulking of the left main stem lesion.

In terms of the procedure itself, we use a standard rotation speed of 160,000 RPM, which is a nice balance between giving you good cutting going forward without the risk of heating and causing lots of distal debris.

Very rarely we would step up to a higher rotational speed if we really got a lesion that won't cross.

Here in Oxford, we use a continuous flush of heparinized saline, which has verapamil and GTN within the continual flush running at low dose, which definitely does help with the risk of low reflow after rotational atherosclerosis.

So that was the question that we needed to answer quite