ANGIOSCOPIC EVALUATION OF ROTATIONAL ATHERECTOMY FOLLOWED BY ADDITIONAL BALLOON ANGIOPLASTY VERSUS BALLOON ANGIOPLASTY ALONE IN CORONARY-ARTERY DISEASE - A PROSPECTIVE, RANDOMIZED STUDY

Objectives. This study sought to compare, by angioscopy, the morpholog ic changes induced by rotational atherectomy, followed by additional a ngioplasty, with those observed after balloon angioplasty alone. Backg round. Rotational atherectomy and balloon angioplasty act by different mechanisms, which could explain the difference in morphologic changes induced by these two techniques. Methods. The study group included 50 patients with 50 lesions who were randomly assigned to undergo rotati onal atherectomy (n = 24) or balloon angioplasty (n = 26). Rotational atherectomy with a single burr (similar or equal to 70% of coronary di ameter) was systematically followed by additional balloon angioplasty. Angioscopy was performed immediately after the procedure. Abnormal an gioscopic findings were 1) flaps, graded from 1 to 3 (1 = intimal flap ; 2 = flap protruding into <50% of the lumen; 3 = flap protruding into greater than or equal to 50% of the lumen); 2) thrombi, graded from 1 to 3 (1 = flat deposits; 2 = protruding but nonocclusive thrombus; 3 = occlusive thrombus); 3) subintimal hemorrhage; 4) longitudinal disse ction. The two groups were comparable for clinical and angiographic ba seline data. Results. On angioscopy, flaps were observed less frequent ly after rotational atherectomy followed by additional balloon angiopl asty (8 [33%] of 24 lesions) than after balloon angioplasty alone (14 [54%] of 26 lesions, p = 0.08) and were also less severe (grade 1 in 6 lesions, grade 2 in 2 and grade 3 in none vs. grade 1 in 4 lesions, g rade 2 in 5 and grade 3 in 5). Longitudinal dissections were also sign ificantly less frequent: one versus six (p = 0.05). There was no diffe rence in the incidence of angioscopic thrombi (p = 0.16) or subintimal hemorrhage (p = 0.15), but the power to detect a significant differen ce was low for these variables (37% and 26%, respectively). Conclusion s. Rotational atherectomy followed by additional balloon angioplasty l eads to fewer angioscopic dissections and a trend toward fewer intimal flaps than balloon angioplasty alone. However, our angioscopic differ ences did not lead to an outcome difference between the two groups. (C ) 1997 by the American College of Cardiology.