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described transient wall motion abnormalities in 22 of 22 patients. Thus, our finding provides supplemental information to explain the mechanism of myocardial dysfunction during and early after rotational atherectomy. CONCLUSION Despite the absence of elevation of myocardial enzymes, significant scintigraphic perfusion defects could be demon strated in the majority of patients. Thus, transient myocardial ischemia seems to be common and a closely procedure-related phenomenon. Lesion calcification could be identified as a risk factor for larger perfusion defects. Serial SPECT imaging with quantitative analysis as proposed in this study may be used in the future to evaluate pharmacological approaches to reduce rotational atherectomy-induced hypoperfusion