Effect of rotational atherectomy on the coronary microcirculation in patients with angina pectoris

The coronary microcirculation can be impaired by ablated debris just after a rotational atherectomy procedure, but the specific effects of rotablation on the microcirculation have not been investigated. The present study examined the effects of rotational atherectomy on the coronary microcirculation by analyzing coronary flow reserve (CFR) and the component parameters of the coronary flow-pressure loop.

This study included 31 patients with angina pectoris who underwent stent implantation after rotational atherectomy and with < 50% diameter stenosis at 6-month follow-up (i.e. without clinical restenosis). The CFR, the flow-pressure slope index (FPSI) and zero-flow pressure were measured using the FloWire Doppler guidewire in both treated and untreated reference vessels without stenosis immediately after and on 6 months from the rotational atherectomy procedure.

CFR and FPSI in the treated vessels were significantly lower than in the untreated reference vessels without stenosis just after rotational atherectomy (CFR: 2.1 +/- 0.5 vs 2.6 +/- 0.7, p < 0.05; FPSI: 1.61 +/- 0.8 vs 2.35 +/- 0.9 cm/sec/mmHg, p < 0.05), but no significant differences were observed in CFR or FPSI between these same sets of arteries at follow-up. There was also a significant correlation between the extent of attenuation of CFR and total ablation time (r = - 0.54, p < 0.01).

Rotational atherectomy attenuates CFR by reducing coronary artery conductance, probably due to coronary microvessel obstruction with the debris ablated during the procedures of rotational atherectomy.