Rotational atherectomy (RA) holds the distinction of being the only interventional device developed in the first 2 decades of interventional cardiology to survive to the present in its original form. In the three decades after its 1993 approval by the US Food and Drug Administration, the fundamental design of the RA catheter has not changed. In this, the RA catheter is like the coelacanth and the horseshoe crab – either forgotten by evolution or originally so well-designed that it defies improvement.