Virtual Assessment of Coronary Microcirculation Before and After Rotational Atherectomy

Background

Calcified coronary lesions remain a major challenge during percutaneous coronary intervention (PCI). Rotational atherectomy (RA) (Boston Scientific) is a well-established tool used to modify calcified plaques and facilitate stent delivery. Despite its mechanical benefits, RA may adversely affect coronary microcirculation through distal plaque debris embolization. Angiography-derived microvascular resistance (AMR) (Pulse Medical) is a wire-free index correlated with invasive indices such as the index of microcirculatory resistance (IMR), which allows assessment of microcirculatory resistance directly from angiographic images, without a pressure wire or adenosine. The objective of this study is to evaluate changes in AMR before and after RA and to identify clinical, angiographic, and procedural predictors of postprocedural coronary microvascular dysfunction (CMD).