Angiographic and histologic findings in high frequency rotational ablation in coronary arteries in vitro

High-frequency rotational angioplasty is a recently developed method for coronary angioplasty in the catheter laboratory. An elliptical burr tip (phi 1.25-2.0 mm) with embedded diamant chips (phi 40-50 microns) is rotated by a helical drive shaft at 150,000-180,000 rpm. The burr is advanced over a 0.009-inch coaxial guide wire. To show the effects of this approach in diseased and healthy vessels, which may be present before and behind a stenosis, 17 atherosclerotic coronary arteries of nine human hearts, and 18 normal coronary arteries of nine pig hearts were treated by this method in vitro. Standardized coronary angiography was performed before and after Rotablator treatment, followed by histological examination. From these data the burr-to-vessel-diameter ratio was calculated for each vessel segment and compared with the angiographical and histological outcome. Partial or complete removal of the circumference of the innermost vessel wall layers was observed regularly. The average removal of tissue in human coronary arteries was limited to the intimal layer and in the pig coronary arteries to the internal elastic membrane. In the pig coronary arteries no intimal tears or dissections occurred, in human coronary arteries tears could be seen frequently (13 of 17 vessels (76%)). Media tears were observed in 3 of 17 vessels; one (2%) media dissection could be demonstrated; no perforation occurred. Thus, the in vitro studies suggest that coronary rotational angioplasty has only a slight effect on the vessel segment next to a stenosis, regardless of the burr-to-vessel-diameter ratio.(ABSTRACT TRUNCATED AT 250 WORDS)