INCREMENTAL VALUE OF INTRAVASCULAR ULTRASOUND DURING ROTATIONAL CORONARY ATHERECTOMY

During the last several years, major improvements in intravascular ult rasound image quality have led to new and important information about the clinical application of rotational atherectomy. Ultrasound is prov iding data on the mechanism of lumen enlargement, burr sizing, and the effects of the procedure on different plaque morphologies. This infor mation is often important for optimizing device selection and procedur al success, as well as for minimizing complications. In this review we first discuss the currently available data regarding the mechanisms o f lumen enlargement following rotational ablation and the implications of these findings for lesion and patient selection. We review how thi s data is modifying several of the technical aspects of the rotational ablation procedure in the interventional laboratory. We then assess t he available data that suggest that preprocedural ultrasound examinati on may eventually help to identify lesions at high risk for adverse ou tcome with stand-alone balloon angioplasty or stent placement. These u ltrasound data may help triage many of these targets to initial debulk ing with rotational ablation. Finally, we review data that suggest tha t ultrasound analysis has important implications for comparative trial s of new devices, particularly trials of the Rotabalator(TM). (C) 1996 Wiley-Liss, Inc.