Effects of rotational atherectomy with a reduced burr-to-artery ratio on coronary no-reflow.
OBJECTIVE
The use of rotational atherectomy in addition to standard percutaneous coronary interventional procedures, although it improves coronary blood flow dynamics by improving vessel geometry, is often associated with distal embolization and the no-reflow phenomenon. We sought to evaluate the safety and effectiveness of a burr size/reference artery diameter (RAD) ratio <0.7 in rotational atherectomy in order to reduce the distal embolization and then to analyze the procedural and peri-procedural no-reflow phenomenon.


METHODS
Between March 1999 and May 2003, 50 consecutive patients with a chronic stable angina lasting more than 3 months underwent rotablator atherectomy, adjunctive stent im-plantation (primary coronary stenting, PCS) or plain old balloon angioplasty (POBA) in case of de novo lesions or in stent restenosis, respectively. We analyzed the target vessel myocardial blush grade and the troponin I, creatine kinase and CK-MB values at 1.6 and every 8 h during the first day and then daily until discharge.


RESULTS
Procedural success was achieved in all 50 patients (mean age 55+/-11 years; 45 males, 5 females). Quantitative angiography revealed, in the group treated with PCS, an increase in minimal lumen diameter (MLD) from 0.88+/-0.39 mm at baseline to 1.4+/-0.63 mm after rotablator (p<0.01) to 2.85+/-0.9 mm after stent implantation (p<0.01). On the other hand, for the group treated with POBA, the MLD changed from 1.8+/-0.32 mm at baseline to 2.2+/-0.54 mm after rotablator (p=0.6) to 3.28+/-0.91 mm after adjunctive balloon angioplasty (p<0.01). No statistically significant changes have been observed between myocardial blush grade and enzymes between baseline and after the procedure.


CONCLUSIONS
Rotablator atherectomy with a reduced burr size/RAD ratio is a safe and effective interventional procedure without any peri-procedural no-reflow phenomenon.
Sardella
G
G
Department of Cardiovascular and Respiratory Sciences, University La Sapienza, Policlinico Umberto I, Rome, Italy. rino.sardella@uniroma1.it
De Luca
L
L
Adorisio
R
R
Di Russo
C
C
Fedele
F
F
D000328:Adult; D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged