Percutaneous rotational atherectomy is mainly utilized in contemporary interventional practice to alter lesion compliance, facilitating stent delivery and antirestenotic drug delivery at the site of the underlying lesion. This enables a percutaneous revascularization strategy in a group of patients who would otherwise require a surgical revascularization. We identify and present three novel uses for this device in percutaneous coronary and peripheral interventional procedures, which further expands the applications of rotational atherectomy.