Atherectomy devices and methods

A rotational atherectomy system for performing rotational atherectomy to remove stenotic lesion material from a blood vessel of a patient, the system comprising:

• an actuator handle assembly comprising a housing and a carriage assembly that is movably coupled to the housing;
• an elongate flexible drive shaft comprising a torque-transmitting coil, the drive shaft defining a longitudinal axis and a central drive shaft lumen extending along the longitudinal axis, the drive shaft rotatably coupled to the carriage assembly such that moving the carriage assembly in relation to the housing correspondingly moves the drive shaft in relation to the housing;
• a set of eccentric abrasive elements fixed to a distal portion of the drive shaft and spaced apart from one another by at least 50% of an outer diameter of a largest one of the set of eccentric abrasive elements, the set of eccentric abrasive elements including at least a first, second, and third eccentric abrasive elements fixed to the drive shaft such that a center of mass of each eccentric abrasive element is offset from the longitudinal axis, the center of mass of the first eccentric abrasive element being offset from the longitudinal axis at a first radial angle, the center of mass of the second eccentric abrasive element being offset from the longitudinal axis at a second radial angle that differs from the first radial angle, the center of mass of the third eccentric abrasive element being offset from the longitudinal axis at a third radial angle that differs from the first radial angle and the second radial angle;
• a concentric abrasive distal stability element having a cylindrical shape with an abrasive exterior coating and a center of mass aligned with the longitudinal axis, the concentric abrasive distal stability element fixed to the drive shaft and distally spaced apart from a distal-most abrasive element of the set of eccentric abrasive elements by a distal separation distance;
• a sheath extending from the actuator handle assembly, the drive shaft slidably disposed within a lumen defined by the sheath;
• and
• a controller operably coupleable to the actuator handle assembly by a cable, the controller configured to provide output to the actuator handle assembly that causes the actuator handle assembly to drive the rotation of the drive shaft about the longitudinal axis, the controller including a user interface with a plurality of selectable inputs corresponding to differing speeds of rotation of the drive shaft.