Coronary artery morphologic features after coronary rotational atherectomy: Insights into mechanisms of lumen enlargement and embolization

The coronary arteries and myocardium from two patients who died after coronary rotational atherectomy were analyzed to gain insights into the mechanisms of lumen enlargement and to document embolization of calcified plaque. Rotational atherectomy resulted in sharp cuts in plaque, producing a relativ...

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Bibliographic Details
Published in:The American heart journal 1995-06, Vol.129 (6), p.1058-1067
Main Authors: Farb, Andrew, Roberts, David K., Pichard, Augusto D., Kent, Kenneth M., Virmani, Renu
Format: Article
Language:English
Subjects:
Aged
Angioplasty, Balloon - adverse effects
Atherectomy, Coronary - adverse effects
Biological and medical sciences
Calcinosis - pathology
Calcinosis - surgery
Coronary Angiography
Coronary Artery Disease - pathology
Coronary Artery Disease - surgery
Coronary Artery Disease - therapy
Coronary Circulation
Coronary Vessels - pathology
Diseases of the cardiovascular system
Embolism, Cholesterol - etiology
Fatal Outcome
Female
Follow-Up Studies
Humans
Medical sciences
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Rupture
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Summary:The coronary arteries and myocardium from two patients who died after coronary rotational atherectomy were analyzed to gain insights into the mechanisms of lumen enlargement and to document embolization of calcified plaque. Rotational atherectomy resulted in sharp cuts in plaque, producing a relatively smooth luminal surface. When extensive nodular calcific atherosclerosis was present, the luminal surface was focally uneven with exposure of jagged calcified plaque to blood flow. Deep plaque fissures and medial dissections were also seen. These fissures may have been created by the rotoblator or by adjunctive balloon angioplasty. Multiple calcific atheroemboli were present after rotoblator use in plaques containing extensive nodular calcification; in moderately calcified plaque only one small atheroembolus was found. Thus embolization of calcified plaque can occur after rotational atherectomy and may correlate with the severity of plaque calcification. Rotational atherectomy produces a focally smooth, sharp-edged, luminal surface, a lumen enlargement mechanism different from balloon angioplasty.
ISSN:0002-8703
1097-6744
DOI:10.1016/0002-8703(95)90384-4