Abstract
Background
Rotational atherectomy (rotablation) frequently results in transient myocardial hypoperfusion due to peripheral vessel obstruction. This study compares the incidence, extent, and severity of perfusion defects induced by rotablation of de novo coronary lesions with rotablation of in- stent restenosis.
Methods and Results
Twenty- five patients undergoing rotablation for restenosed stents (group A) were studied by technetium 99m sestamibi single photon emission computed scintigraphy at rest before rotablation, during rotablation, and 2 days after the procedure. For semiquantitative analysis, perfusion in 24 left ventricular regions was expressed as percentage of maximal sestamibi uptake. The results were compared with those of 25 patients treated for de novo coronary lesions (group B). Transient perfusion defects were observed in 22 (88%) of 25 patients in group A and, similarly, in 23 (92%) of 25 in group B. Perfusion was significantly reduced during rotablation in 3.1 ± 2.6 (mean ± SD) regions in group A and in 3.3 ± 2.5 regions in group B. Perfusion in the region with maximal reduction during rotablation in groups A and B was 77% ± 13% and 76% ± 15% at baseline. Technetium uptake decreased to 59% ± 19% and 54% ± 14% during rotablation (P < .001 vs baseline, P = not significant for A vs B) and returned to 76% ± 16% and 76% ± 15% after rotablation. Intravascular ultrasonography indicated no correlation between the volume of ablated plaque and the extent and severity of perfusion defects in in- stent restenosis.
Conclusions
Incidence, extent, and severity of rotablation- related transient hypoperfusion are influenced by neither the type nor the quantity of ablated plaque material. Thus embolization of ablated plaque may be less important compared with other factors such as microcavitation or platelet aggregation.
Similar content being viewed by others
References
Ellis SG, Popma JJ, Buchbinder M, et al. Relation of clinical presentation, stenosis morphology, and operator technique to the procedural results of rotational atherectomy and rotational atherectomy-facilitated angioplasty. Circulation 1994;89:882–92.
Teirstein PL, Warth DC, Haq N, et al. High speed rotational coronary atherectomy for patients with diffuse coronary artery disease. J Am Coll Cardiol 1991;18:1694–701.
Reisman M, Harms V, Whithlow P, Feldman T, Fortuna R, Buchbinder M. Comparison of early and recent results with rotational atherectomy. J Am Coll Cardiol 1997;29:353–7.
Koch K-C, Kleinhans E, Klues HG, et al. Quantitative assessment of transient regional ischemia during high-speed rotational atherectomy by technetium-99m sestamibi SPECT. J Nucl Med 1998;39:402–8.
Gordon PC, Gibson CM, Cohen DJ, Carrozza JP, Kuntz RE, Baim DS. Mechanisms of restenosis and redilation within coronary stents-quantitative angiographic assessment. J Am Coll Cardiol 1993;21:1166–74.
Mintz GS, Hoffmann R, Mehran R, et al. In-stent restenosis. the Washington Hospital Center experience. Am J Cardiol 1998;81: 7E-13E.
Bottner RK, Hardigan KR. High-speed rotational atherectomy for in-stent restenosis. Cathet Cardiovasc Diagn 1997;40:144–9.
Dauerman HL, Baim DS, Cutlip DE, et al. Mechanical debulking versus balloon angioplasty for the treatment of diffuse in-stent restenosis. Am J Cardiol 1998;82:277–84.
Lee S-G, Lee CW, Cheong S-S, et al. Immediate and long-term outcomes of rotational atherectomy versus balloon angioplasty alone for treatment of diffuse in-stent restenosis. Am J Cardiol 1998;82:140–3.
Dahl vom J, Radke P, Haager P, et al. Clinical and angiographic predictors of restenosis after rotational atherectomy for treatment of diffuse in-stent restenosis. Am J Cardiol 1999;83:862–7.
Reisman M, Buchbinder M. Rotational ablation. The Rotablator catheter. Cardiol Clin 1994;12:595–610.
Reisman M. Technique and strategy of rotational atherectomy. Cath Cardiovasc Diagn 1996;38:2–14.
Dussaillant GR, Mintz GR, Pichard AD, et al. Effect of rotational atherectomy in noncalcified atherosclerotic plaque. a volumetric intravascular ultrasound study. J Am Coll Cardiol 1996;28:856–60.
Neumeier D, Prellwitz W, Wuerzburg U, et al. Determination of creatine kinase isoenzyme MB activity using immunological inhibition of creatine kinase M subunit activity. Clin Chim Acta 1976;73:445–51.
Katus HA, Looser S, Hallermeyer K, et al. Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin Chem 1992;38.
Hansen DD, Auth DC, Vracko R, Ritchie JL. Rotational atherectomy in atherosclerotic rabbit iliac arteries. Am Heart J 1988;115:160–5.
Friedman HZ, Elliott MA, Gottlieb GJ, O’Neill WW. Mechanical rotational atherectomy. the effects of microparticle embolization on myocardial blood flow and function. J Intervent Cardiol 1989;2:77–83.
Farb A, Roberts DK, Pichard AD, Kent KM, Virmani R. Coronary artery morphologic features after coronary rotational atherectomy. insights into mechanisms of lumen enlargement and embolization. Am Heart J 1995;129:1058–67.
Bowers TR, Stewart RE, O’Neill WW, Reddy VM, Safian RD. Effect of rotablator atherectomy and adjunctive balloon angioplasty on coronary blood flow. Circulation 1997;95: 1157–64.
Zotz RJ, Erbel R, Phillip A, et al. High-speed rotational angioplasty induced echo contrast in vivo and in vitro optical analysis. Cath Cardiovasc Diagn 1998;26:98–109.
Williams MS, Coller BS, Väänänen HJ, Scudder LE, Sharma SK, Marmur JD. Activation of platelets in platelet-rich plasma by rotablation is speed dependent and can be inhibited by abciximab (c7E3 Fab; ReoPro). Circulation 1998;98:742–8.
Reisman M, Speck SP, Peterson JL, Westcott RJ, et al. The impact of ReoPro or lower speeds on platelet aggregation during rotational atherectomy [abstract]. J Am Coll Cardiol 1998;31:455A.
Braden GA, Love WM, Applegate RJ, Young TM, Sane DC. Abciximab decreases the incidence and magnitude of non-Q wave myocardial infarction associated with rotational atherectomy [abstract]. J Am Coll Cardiol 1998;31:237A.
Koch KC, Dahl vom J, Kleinhans E, et al. Influence of a platelet GPIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestamibi scintigraphy. J Am Coll Cardiol 1999;33:998–1004.
Hoffmann R, Mintz GS, Dussaillant GR, et al. Patterns and mechanisms of in-stent restenosis. a serial intravascular ultrasound study. Circulation 1996;94:1247–54.
Nobuyoshi M, Kimura T, Ohishi H, et al. Restenosis after percutaneous transluminal coronary angioplasty. pathologic observations in 20 patients. J Am Coll Cardiol 1991;17:433–9.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koch, KC., Radke, P.W., Kleinhans, E. et al. Mechanisms of myocardial hypoperfusion during rotational atherectomy of de novo coronary artery lesions and stenosed coronary stents: Insights from serial myocardial scintigraphy. J Nucl Cardiol 9, 304–311 (2002). https://doi.org/10.1067/mnc.2002.120363
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1067/mnc.2002.120363