[Intracoronary platelet reactivity during atherectomy-assisted PCI: A prospective mechanistic study]

Rotational atherectomy (RA) and orbital atherectomy (OA) are widely used for plaque modification in severely calcified coronary lesions. Historical concerns have suggested that high rotational speeds may induce platelet activation during percutaneous coronary intervention (PCI), but data in the context of contemporary procedural strategies and dual antiplatelet therapy (DAPT) remain limited.

In this prospective single-centre study, 59 patients with chronic coronary syndrome undergoing atherectomy-assisted PCI were enrolled. RA was performed with high-speed runs (≈180,000rpm) combined with low-speed exploratory runs (≈110,000rpm) while OA used systematic low-speed runs (80,000rpm) and selective high-speed runs (120,000rpm). All patients received aspirin and a P2Y12 inhibitor before PCI. Platelet reactivity was assessed at predefined procedural time points using the VASP (vasodilator-stimulated phosphoprotein) assay and aggregation tests with arachidonic acid (AA) and adenosine diphosphate (ADP).

Among 60 patients (mean age 74.1 years, 72.8% male), 38 underwent RA and 22 OA. No significant increase in platelet reactivity was observed between baseline and final measurements for any test (AA: P=0.174; ADP: P=0.437; VASP: P=0.071), with values remaining stable or slightly decreased. Subgroup analyses showed consistent results for RA and OA, with no significant variation by technique. Procedural kinetics over four time points showed no transient elevation of platelet reactivity at any stage. All procedures were angiographically successful.

Under contemporary DAPT, atherectomy-assisted PCI with RA or OA does not induce platelet hyperreactivity. These results support the biological safety of modern atherectomy strategies, although their mechanistic nature warrants confirmation in larger outcome-driven studies.