CORONARY-ARTERY MORPHOLOGIC FEATURES AFTER CORONARY ROTATIONAL ATHERECTOMY - INSIGHTS INTO MECHANISMS OF LUMEN ENLARGEMENT AND EMBOLIZATION

The coronary arteries and myocardium from two patients who died after coronary rotational atherectomy were analyzed to gain insights into th e mechanisms of lumen enlargement and to document embolization of calc ified plaque, Rotational atherectomy resulted in sharp cuts in plaque, producing a relatively smooth luminal surface, When extensive nodular calcific atherosclerosis was present, the luminal surface was focally uneven with exposure of jagged calcified plaque to blood flow, Deep p laque fissures and medial dissections were also seen, These fissures m ay have been created by the rotoblator or by adjunctive balloon angiop lasty, Multiple calcific atheroemboli were present after rotoblator us e in plaques containing extensive nodular calcification; in moderately calcified plaque only one small atheroembolus was found, Thus emboliz ation of calcified plaque can occur after rotational atherectomy and m ay correlate with the severity of plaque calcification. Rotational ath erectomy produces a focally smooth, sharp-edged, luminal surface, a lu men enlargement mechanism different from balloon angioplasty.