995-21 Coronary Flow Reserve Does Not Improve After Successful Rotablator Atherectomy and Adjunctive Angioplasty

Although lumen enlargement after coronary balloon angioplasty(PTCA) is associated with improvement in coronary flow velocity (CFV) and coronary flow reserve (CFR). Rotablator atherectomy (MRA) results in lumen enlargement and distal microembolization, Which may attenuate coronary blood flow and CFR. Accordingly, spectral flow velocities were obtained with Doppler Flowires in 16 arteries (9 LAD, 3 LCX, 4 RCA in 16 patients, [age 62 ± 12 yrs]) before, after MRA and after adjunctive PTCA. Basal (BCFV) and peak hyperemic flow velocities (PCFV) after intracoronary adenosine (10-30 μg) were recorded in identical angiographic positions. Blood pressure and heart rate were constant between measurements. Diameter stenosis (DS) was determined by quantitative coronary angiography. Pre-Intervention Post MRA Post PTCA BCFV (cm/s) 16.3 ± 66 25.0 ± 13.4 * 36.8 ± 13.9 * PCFV (cm/s) 21.1 ± 11.1 33.7 ± 18.7 * 48.9 ± 24.S * CFR 1.28 ± 031 1.20 ± 0.36 † 1.44 ± 0.38 † 05(%) 63 ± 17 49 ± 18 ** 28 ± 12 ** * p l 0.0001 ** p l 001 † P = NS, compared with baseline (ANOVA) Conclusions 1) MRA and adjunctive PTCA result in significant increases in coronary lumen dimensions. basal flow velocity and hyperemic peak coronary flow velocity. 2) Failure to increase coronary flow reserve after MRA and adjunctive PTCA is due to proportional increases in basal and hyperemic flow velocity and not to impaired coronary artery flow from microembolization.