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Impact of atherectomy devices on coronary microcirculation during percutaneous coronary intervention

Satoshi Nakawatase1, Yasuhiro Ichibori1, Yohei Sotomi2

  • 1Cardiovascular Division, Osaka Keisatsu Hospital, Japan.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|March 31, 2026
PubMed

Insights

Atherectomy devices (ADs) used during percutaneous coronary intervention (PCI) do not negatively impact coronary microcirculatory function. However, AD use is associated with increased troponin levels, suggesting potential microembolization and localized myocardial injury.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Post-percutaneous coronary intervention (PCI) abnormalities in index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) indicate microvascular dysfunction and predict adverse outcomes.
  • Atherectomy devices (ADs) are used to treat complex calcified lesions, but their effect on post-PCI microcirculation is not well understood.

Purpose of the Study:

  • To evaluate the impact of atherectomy devices (ADs) on post-procedural index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) in patients undergoing PCI.
  • To compare microcirculatory indices and myocardial injury markers between patients treated with and without ADs.

Main Methods:

  • Seventy-five patients with left anterior descending artery lesions underwent PCI with (n=42) or without (n=33) ADs.
  • Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured post-procedure using bolus thermodilution.
  • High-sensitivity cardiac troponin T levels were assessed, and propensity score matching was applied.

Main Results:

  • No significant differences in post-procedural IMR or CFR were observed between the AD (+) and AD (-) groups (P > 0.05).
  • These findings remained consistent after propensity score matching.
  • The AD (+) group showed significantly higher post-PCI high-sensitivity cardiac troponin T levels compared to the AD (-) group (P = 0.003).

Conclusions:

  • Contemporary atherectomy device use does not appear to impair coronary microcirculatory function immediately after PCI.
  • Elevated troponin T levels in the AD (+) group suggest microembolization may cause subclinical myocardial injury during atherectomy.
Abstract

Keywords:
AtherectomyCoronary microvascular dysfunctionIndex of microcirculatory resistancePercutaneous coronary intervention

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