Percutaneous transluminal coronary rotational ablation: early follow-up at 24 hours by quantitative angiography

Abstract

Coronary rotational ablation with the RotablatorTM is manifesting significant promise for the treatment of atherosclerotic obstructions. Based upon careful serial measurements in 134 patients by quantitative coronary angiography, the device improved minimal luminal diameter from 0.69 ± 0.27 mm to 1.71 ± 0.33 mm 24 hours later. Lesions treated with the RotablatorTM do not show elastic recoil, but, by contrast, manifest even larger luminal diameters at 24 hours as compared to immediately post ablation. Although flow-mediated dilation or intrinsic metabolic factors may contribute to this phenomenon, the improvement in vessel lumen at 24 hours post-treatment appears to be related to relief of vasospasm. In some cases, balloon adjunctive dilation is used successfully when the initial minimal luminal diameter post-burr is in the range of 1.2 to 1.3 mm; however, the final result at 24 hours appears to be no different between those patients treated with burr alone as compared to burr ablation followed by balloon dilation. Further studies are necessary to determine if burrs of larger size can achieve a larger post-treatment luminal diameter and whether such use will be associated with higher complication and restenosis rates.