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 contributions of rotational coronary atherectomy (RA) and adjunctive percutaneous transluminal coronary balloon angioplasty (PTCA), serial measurements were recorded in 70 consecutive patients by quantitative coronary angiography before RA, after RA, after adjunctive PTCA, and 24 hours 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 mm2 to 1.63 ± 0.60 mm2 (p < 0.001) after RA and to 3.97 ± 1.68 mm2 (p < 0.001) after PTCA. Both 24-hour MLD and MLA showed a trend toward reduced values (2.07 ± 0.45 mm and 3.52 ± 1.70 mm2, respectively) when compared with immediate results after PTCA. The 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 MLA after RA and after PTCA were 0.99 ± 0.49 mm2 and 2.34 ± 1.41 mm2, respectively (p < 0.001). The respective contributions of RA and PTCA are highly variable, but in general, balloon dilatation accounts for most of the gain in lumen area and therefore is not an adjunctive but a primary technique.