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Quantitative Assessment of Transient Regional Ischemia During Rotational Atherectomy

Departments of Internal Medicine I (Cardiology) and Nuclear Medicine, University Hospital, RWTH Aachen, Aachen, Germany

Correspondence: For correspondence or reprints contact: Juergen vom Dahl, MD, Medizinische Klinik I, Universitätsklinikum der RWTH Aachen, Pauwelstrasse 30, D-52057 Aachen, Germany.

ABSTRACT

Sustained myocardial ischemia with angina pectoris, electrocardiographic changes and subsequent non-Q-wave infarctions has been reported during percutaneous transluminal rotational atherectomy of complex coronary lesions. The purpose of this study was to evaluate the effect of rotational atherectomy on regional myocardial perfusion as assessed by serial ^99mTc-sestamibi SPECT imaging with semiquantitative tracer uptake analysis. Methods:Twenty-nine consecutive patients with anginal symptoms, complex coronary lesions (all Type B and Type C) and preserved left ventricular function were studied using resting ^99mTc-sestamibi SPECT before rotational atherectomy, during and 2 days after the procedure. For semiquantitative computerized analysis, the left ventricular myocardium was divided into 24 regions, and regional perfusion was expressed as percentage of maximal sestamibi uptake. Results: Visual analysis of scintigraphic images revealed transient perfusion defects corresponding to the revascularized vessel in 26 of 29 patients, whereas three patients had no transient hypoperfusion. During rotational atherectomy, perfusion decreased significantly (> 2 s.d. below normal mean) in 3.1 ± 2.4 regions (range 1–10). Perfusion in the territory of the revascularized vessel was 75% ± 11% at baseline, decreased to 67% ± 12% during rotational atherectomy (p < 0.001) and normalized again after rotational atherectomy to 78% ± 8% (p < 0.001). Similarly, perfusion in the region with the maximal reduction decreased from 74% ± 15% at baseline to 55% ± 14%(p < 0.001) during the procedure and returned to 74% ± 16% (p < 0.001) following the intervention. In calcified stenoses, the extent of perfusion defects was larger as compared to noncalcified (4.2 ± 2.5 versus 2.3 ± 2.0 regions/patient, p < 0.05). Conclusion: During rotational atherectomy, myocardial hypoperfusion occurs. The transient nature of this perfusion defect can be demonstrated and quantified by serial ^99mTc SPECT. This model may prove useful to assess the effects of pharmacological approaches to reducing myocardial hypoperfusion during coronary rotational atherectomy.

Key Words: coronary artery disease • myocardial perfusion • rotational atherectomy • SPECT • technetium-99m-sestamibi

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				H. Tomoda and N. Aoki Prolongation of QT Interval as a Predictor of No-Reflow Induced by Rotational Atherectomy Angiology, July 1, 2002; 53(4): 435 - 441. [Abstract] [PDF]

				K.-C. Koch, J. vom Dahl, E. Kleinhans, H. G. Klues, P. W. Radke, S. Ninnemann, G. Schulz, U. Buell, and P. Hanrath 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., March 15, 1999; 33(4): 998 - 1004. [Abstract] [Full Text] [PDF]