High-speed rotational atherectomy and coronary stenting: QCA and QCU analysis

To evaluate the acute effect of pretreatment with high-speed rotational atherectomy (HSRA) on stent deployment (rotastenting), we studied 33 patients with rotastenting of 40 segments, 34 patients with 40 coronary segments treated with Palmaz-Schatz stenting alone, and 34 patients with 40 segments treated with HSRA. The HSRA- and stent-alone patient groups were selected retrospectively by matching the quantitative coronary angiography (QCA) reference diameter (D ref). QCA revealed similar baseline percent of stenosis (85.3% +/- 12.4%), minimal luminal diameter (MLD), and D ref. The percent area expansion was calculated as a ratio between the minimal intrastent area and the reference area measured by intracoronary ultrasound. The rotastent group was characterized by more frequent calcification compared to HSRA and stent groups (67.5% vs. 20% and 12.5%; P < 0.01). Lesion length determined by QCA was longer both in the HSRA and the rotastent groups vs. the stent-alone group (21.1 +/- 12.3 and 20.9 +/- 4.3 vs. 17.0 +/- 7.7 mm; P < 0.05). In this small study, there was no difference demonstrated between final MLD in the rotastent and stent-alone groups. However, a smaller MLD was achieved in the HSRA group (3.0 +/- 0.7 vs. 3.1 +/- 0.5 vs. 2.5 +/- 0.7 mm, respectively; P < 0.01). The degree of stent expansion was higher in the rotastent group compared to the stent-alone group (91.9% +/- 4.4% vs. 79.7% +/- 3.4%; P < 0.03) and the % residual area of plaque was less for the rotastent group than for the stent-alone group (12.1% +/- 13.2% vs. 21.1% +/- 17.5%; P = 0.03). These data suggest that antecedent HSRA atheroma debulking using HSRA results in improved intravascular stent expansion and reduction in residual plaque, facilitating optimal stent deployment.