QUANTITATIVE ANGIOGRAPHY OF CORONARY-ARTERY DIMENSIONS 24 HOURS AFTERROTATIONAL ATHERECTOMY

Rotational atherectomy results in platelet activation and heat generat ion, which may impact artery size immediately after treatment. In addi tion, arteries treated with balloon angioplasty may exhibit recoil wit hin 24 hours. In this study, arteries treated with rotational atherect omy, with and without adjunctive balloon angioplasty, were analyzed by quantitative coronary angiography to determine the effect of rotation al atherectomy on the dynamic behavior of the arterial wall within 24 hours after the procedure. Quantitative coronary angiography was perfo rmed at a core laboratory. Coronary angiogram acquisitions were preced ed by intracoronary nitroglycerin injections and were repeated using i dentical angles of projection. Proximal and distal reference vessel di ameters were 2.55 +/- 0.60 and 2.28 +/- 0.51 mm, respectively, and did not change from pre-to postprocedure. Both were larger the following day increasing to 2.72 +/- 0.65 and 2.52 +/- 0.52 mm, respectively, (p <0.001). Minimum luminal diameter (MLD) increased from 0.70 +/- 0.28 m m before to 1.49 +/- 0.34 mm after the procedure and to 1.72 +/- 0.37 mm at 24-hour follow-up (p<0.001). Subset analysis of patients treated with rotational atherectomy alone or rotational atherectomy with adju nctive balloon angioplasty revealed that the increase in luminal diame ters occurred in both subsets. Patients treated with adjunctive angiop lasty had a smaller initial MLD, a larger postprocedure MLD, and no di fference in MLD at 24-hour follow-up compared with stand-alone rotatio nal atherectomy. Subset analysis of 100 patients who had 6-month follo w-up angiography revealed that both a calculated acute gain and chroni c late loss, based on a 24-hour film, differed significantly from valu es using a film acquired immediately after the procedure. However, the slope of the linear regression between acute gain and chronic late lo ss did not differ. Coronary arteries treated with rotational atherecto my with or without adjunctive balloon angioplasty increase significant ly in size during the first 24 hours after the procedure. This phenome non has implications for the calculation of absolute gain and chronic late loss, but not for the linear relation between the 2 quantitative outcomes. (C) 1998 by Excerpta Medica, Inc.