White Thrombosis on Optical Coherence Tomography after Rotational Atherectomy of Severely Coronary Calcified Lesions

Purpose Rotational atherectomy (RA) has improved percutaneous treatment of severe coronary calcified lesions, but the "no-reflow" phenomenon remains a serious complication. Platelet activation by RA may contribute to the no-reflow, we use optical coherence tomography (OCT) to test the effect of RA on white thrombosis that could confirm platelet activation indirectly. Methods We analyzed 53 consecutive patients with coronary angiographic severe calcified lesions. All the patients were examined by OCT. Twenty patients received RA and OCT imaging performed before and after RA and stent implantation. The remaining patients were as a control group and OCT imaging performed before balloon dilatation and after stent implantation. Results The patients were older and higher incidence of Diabetes mellitus in the RA group. In the control group, there was no thrombogenesis during the procedure, but in the RA group, all the target vessels had white thrombosis on OCT after RA. The average number of white thrombus per lesion after RA was 7.23 ± 4.4, and the average length of every white thrombus was 0.51 ± 0.33mm. In Pearson Correlation Analysis, Thrombotic load was related with burr size (r = 0.575, P = 0.040) and rotation number (r = 0.599, P = 0.031). Conclusions White thrombosis during RA is proved by OCT in vivo. Treating calcified lesions with RA may enhance thrombogenesis. These data suggest using a proper therapy to avoid no-reflow during RA.