Although a strategy of “debulk and dilate” may appear intuitively superior to balloon angioplasty (BA) alone, data supporting this concept are lacking. Accordingly, we performed angiographic laboratory analyses of 21 patients (pts) treated with rotational atherectomy (RA) and adjunctive aggressive BA and compared their immediate angiographic outcomes to 21 selected pts treated with BA only. The BA only group was chosen from a large PTCA database to identify a “matched” SA pt for each of the RA pts. Matching was based on clinical and coronary angiographic characteristics. When the two groups were compared at baseline, there were no differences (p>0.05) in terms of age, gender, target lesion location, % stenosis, minimal lumen diameter (MLD), reference diameter, TIMI flow grade, lesion length or presence of calcium, thrombus, or eccentricity. The angiographic results of final outcome were:Charactenstic (mean±1SD)BA AloneRA/BApReference diameter (mm)26±0.42.70±040.800MLD(mm)1.7±0.42.1±0.30.005% Stenosis33.2±13618.9±10.10.000Acute gain (mm)1.1±0.514±0.30.038Dissection (% pts)28.69.50.116Extent of dissection (mm2)2.2±5.109±0.30.057