ANALYSIS OF LOW-SPEED ROTATIONAL ATHERECTOMY FOR THE REDUCTION OF PLATELET-AGGREGATION

Platelet activation is an important determinant of acute outcomes of p ercutaneous intervention. The objective of this study was to assess th e effect of rotational atherectomy on platelet activation in an in vit ro model. Freshly collected heparinized porcine blood was exposed to a 2.0-mm Rotablator(R) burr rotating at one of three speeds: 180,000, 1 40,000, or 0 rpm. The specimens were analyzed immediately for concentr ation and size of platelet aggregates and plasma-free hemoglobin. Ther e were significantly more platelet aggregates of >20-mu m diameter at higher speeds (7,434 +/- 2,193 at 180,000, vs. 2,269 +/- 627 at 140,00 0, vs. 633 +/- 258 aggregates/ml at 0 rpm; P < 0.001), Plasma-free hem oglobin, a simple measure of cell damage, decreased with decreasing ro tational speed (429 +/- 168 mg/dl at 180,000, vs, 88 +/- 44 mg/dl at 1 40,000, vs. 9 +/- 9 mg/dl at 0 rpm; P < 0.0001). In vitro, platelet ac tivation decreases with decreasing burr speed, suggesting that the use of the Rotablator(R) system at its minimum approved speed (140,000 rp m) could prove clinically beneficial. (C) 1998 Wiley-Liss, Inc.