Impact of atherectomy devices on coronary microcirculation during percutaneous coronary intervention.

BACKGROUND

Post-percutaneous coronary intervention (PCI) abnormalities in the index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) reflect microvascular dysfunction and are associated with adverse clinical outcomes. Atherectomy devices (ADs) are commonly employed to optimize stent delivery and expansion in heavily calcified lesions; however, their impact on post-PCI microcirculatory indices remains uncertain. This study aimed to evaluate post-procedural IMR and CFR values in patients undergoing PCI with and without the use of ADs using the bolus thermodilution method.

METHODS

Seventy-five consecutive patients with left anterior descending artery lesions underwent PCI with (AD [+], n = 42) or without (AD [-], n = 33) rotational or orbital atherectomy. IMR and CFR were assessed immediately post-procedure, and high-sensitivity cardiac troponin T levels were measured the following day. Propensity score matching was used to adjust for baseline differences.

RESULTS

There were no significant differences in IMR or CFR between the AD (+) and AD (-) groups (IMR: 16.79 ± 8.02 vs. 17.90 ± 7.63, P = 0.54; CFR: 2.64 ± 2.22 vs. 3.26 ± 1.33, P = 0.14). These findings persisted after matching. However, the AD (+) group demonstrated significantly higher post-PCI troponin T levels (0.32 ± 0.40 vs. 0.12 ± 0.13 ng/ml, P = 0.003).

CONCLUSIONS

Contemporary use of ADs does not appear to adversely affect post-procedural coronary microcirculatory function. Nonetheless, the observed elevation in high-sensitivity cardiac troponin T suggests that microembolization during atherectomy may contribute to subclinical localized myocardial injury.