ROTATIONAL CORONARY ATHERECTOMY WITH ADJUNCTIVE BALLOON ANGIOPLASTY -EVALUATION OF LUMEN ENLARGEMENT BY QUANTITATIVE ANGIOGRAPHIC ANALYSIS

To evaluate the mechanisms of lumen enlargement and the respective con tributions of rotational coronary atherectomy (RA) and adjunctive perc utaneous transluminal coronary balloon angioplasty (PTCA), serial meas urements were recorded in 70 consecutive patients by quantitative coro nary angiography before RA, after RA, after adjunctive PTCA, and 24 ho urs later. Minimal luminal diameter (MLD) increased from 0.85 +/- 0.31 mm to 1.42 +/- 0.27 mm (p < 0.001) after RA and to 2.20 +/- 0.46 mm ( p < 0.001) after PTCA. Minimal luminal area (MLA) increased from 0.64 +/- 0.50 mm(2) to 1.63 +/- 0.60 mm(2) (p < 0.001) after RA and to 3.97 +/- 1.68 mm(2) (p < 0.001) after PTCA. Both 24-hour MLD and MLA showe d a trend toward reduced values (2.07 +/- 0.45 mm and 3.52 +/- 1.70 mm (2), respectively) when compared with immediate results after PTCA. Th e absolute gains in MLD after RA and after PTCA were 0.56 +/- 0.24 mm and 0.79 +/- 0.38 mm, respectively (p < 0.01). The absolute gains in M LA after RA and after PTCA were 0.99 +/- 0.49 mm(2) and 2.34 +/- 1.41 mm(2), respectively (p < 0.001). The respective contributions of RA an d PTCA are highly variable, but in general, balloon dilatation account s for most of the gain in lumen area and therefore is not an adjunctiv e but a primary technique.