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Muoghalu CG, Ofoegbu CC, Ekong NE, Ebirim DA, Alex-Ojei ST, Alqahtani F. Systematic Review of the Efficacy of Orbital Atherectomy in Improving the Outcome of Percutaneous Corornary Intervention in People With Diabetes. Cureus 2023; 15:e50153. [PMID: 38186553 PMCID: PMC10771627 DOI: 10.7759/cureus.50153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
The optimal approach to deal with severe coronary artery calcification (CAC) in people with diabetes remains ill-defined. People with diabetes have a significant risk of developing severe vessel calcification and coronary artery disease (CAD). CAD is the leading cause of death in people with diabetes. Individuals with diabetes mainly present with severe multivessel stenosis, diffuse coronary calcification, and severe atherosclerosis, which are poor prognostic factors of revascularization procedures. Studies have shown that the revascularization of arteries in people with diabetes often results in worse outcomes than in people without diabetes. Coronary artery bypass grafting (CABG) has been recommended as the standard of care for people with DM and complex anatomic diseases, including left main CAD. However, percutaneous coronary intervention (PCI) is more acceptable to patients in clinical practice because of decreased trauma and rapid recovery. Severe CAC has traditionally been challenging for PCI and a frequent indication for surgical revascularization. This study aims to determine the effectiveness of orbital atherectomy (OA) in improving PCI outcomes in patients with diabetes and identify possible adverse effects that preclude its use. The study is reported according to PRISMA and analyzed according to Cochrane guidelines on synthesis without meta-analysis. A comprehensive literature search of EMBASE, Scopus, Web of Science, Cochrane Library, CINAHL, and MEDLINE was conducted for studies that utilized OA before PCI in people with diabetes. A reference list of the eligible articles was also screened. A narrative synthesis was done by representing the data on the effect direction plot, followed by vote counting. Eighteen studies were included in the analysis. Success rate/successful stent delivery was >90%, while freedom from angiographic complication and major adverse cardiovascular and cerebrovascular events (MACCE) were both >80% on the effect direction plot for people with diabetes and those without diabetes. People with diabetes had low event rates similar to those without diabetes. OA appears to be a viable treatment approach for people with diabetes. However, RCTs with a longer duration of follow-up are required to establish the appropriate treatment strategy for severe CAC in people with diabetes.
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Affiliation(s)
| | - Cosmas C Ofoegbu
- Health Sciences, Central Washington College, Enugu, NGA
- Community and Family Medicine, Allith General Hospital, Allith, SAU
| | | | - Danvictor A Ebirim
- Department of Medicine, Federal University Teaching Hospital, Owerri, NGA
| | - Sandra T Alex-Ojei
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
| | - Foziyah Alqahtani
- Department of Cardiac Technology, Imam Abdurahman Bin Faisal University, Dammam, SAU
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2
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Cui F, Tong Y, Liu G, Zhang W, Liu K, Si D, He Y. Intracoronary imaging-guided rotational atherectomy combined with intravascular lithotripsy in the treatment of severe coronary artery calcification-A case report. Front Cardiovasc Med 2023; 10:1184237. [PMID: 37363093 PMCID: PMC10288993 DOI: 10.3389/fcvm.2023.1184237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Background Severe coronary artery calcification increases the difficulty of percutaneous coronary intervention procedures and impairs stent expansion. Herein, we report a case of a patient who was successfully treated with rotational atherectomy using a stepped burr strategy combined with intravascular lithotripsy for plaque modification under intracoronary imaging. Case summary A 65 year-old woman presented to our hospital with recurrent chest pain evolving for 1 year. Coronary angiography showed approximately 80% stenosis of the proximal mid-left anterior descending artery. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) revealed a 360° annular calcification. The calcification was rotablated with 1.5 and 1.75 burrs, and the lesion was undilatable with a 3.0 mm non-compliant balloon at 14 atm. Subsequently, the intravascular lithotripsy was reset for the modification of the calcified lesion. A shockwave balloon measuring 3.0 mm × 12 mm was delivered, and 40 pulses were performed at 6 atm. Intravascular imaging modalities (IVUS and OCT) revealed a circumferential calcified plaque with deep fractures. After post-balloon expansion followed by drug-eluting stent placement with a final stent expansion of 84%, there were no intraoperative complications and no major adverse cardiovascular events within 90 days postoperatively. Conclusion A combination of rotational atherectomy and intravascular lithotripsy may be an effective and complementary strategy for the treatment of severely calcified lesions that cannot be resolved using a single procedure. However, more clinical studies are required to clarify this finding.
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Affiliation(s)
| | | | | | | | | | | | - Yuquan He
- Correspondence: Daoyuan Si Yuquan He
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3
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Picard F, Pighi M, Marquis-Gravel G, Labinaz M, Cohen EA, Tanguay JF. The Ongoing Saga of the Evolution of Percutaneous Coronary Intervention: From Balloon Angioplasty to Recent Innovations to Future Prospects. Can J Cardiol 2022; 38:S30-S41. [PMID: 35777682 DOI: 10.1016/j.cjca.2022.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/30/2022] Open
Abstract
The advances in percutaneous coronary intervention (PCI) have been, above all, dependent on the work of pioneers in surgery, radiology, and interventional cardiology. From Grüntzig's first balloon angioplasty, PCI has expanded through technology development, improved protocols, and dissemination of best-practice techniques. We can nowadays treat more complex lesions in higher-risk patients with favourable results. Guide wires, balloon types and profiles, debulking techniques such as atherectomy or lithotripsy, stents, and scaffolds all represent evolutions that have allowed us to tackle complex lesions such as an unprotected left main coronary artery, complex bifurcations, or chronic total occlusions. Best-practice PCI, including physiology assessment, imaging, and optimal lesion preparation are now the gold standard when performing PCI for sound indications, and new technologies such as intravascular lithotripsy for lesion preparation, or artificial intelligence, are innovations in the steps of 4 decades of pioneers to improve patient care in interventional cardiology. In the present review, major innovations in PCI since the first balloon angioplasty and also uncertainties and obstacles inherent to such medical advances are described.
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Affiliation(s)
- Fabien Picard
- Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
| | - Michele Pighi
- Department of Medicine, University of Verona, Verona, Italy
| | - Guillaume Marquis-Gravel
- Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Marino Labinaz
- Ottawa University Heart Institute, Ottawa, Ontario, Canada
| | - Eric A Cohen
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jean-François Tanguay
- Interventional Cardiology, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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4
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Honton B, Lipiecki J, Monségu J, Leroy F, Benamer H, Commeau P, Motreff P, Cayla G, Banos JL, Bouchou G, Laperche C, Farah B, Rangé G, Lefèvre T, Amabile N. Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative. Int J Cardiol 2022; 365:106-111. [PMID: 35870637 DOI: 10.1016/j.ijcard.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. METHODS Prospective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. RESULTS A total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. CONCLUSIONS In this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.
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Affiliation(s)
- Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
| | - Janusz Lipiecki
- Department of Interventional Cardiology, Pole Santé République, Clermont-Ferrand, France
| | - Jacques Monségu
- Department of Interventional Cardiology, Institut Cardio Vasculaire, Groupe Hospitalier Mutualiste, Grenoble, France
| | - Fabrice Leroy
- Department of Interventional Cardiology, Clinique La Louviere, Lille, France
| | - Hakim Benamer
- Department of Interventional Cardiology, Hôpital La Roseraie, Aubervilliers, France
| | - Philippe Commeau
- Department of Interventional Cardiology, Polyclinique Les Fleurs, Ollioules, France
| | - Pascal Motreff
- Department of Interventional Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Guillaume Cayla
- Department of Interventional Cardiology, Nimes University Hospital, University of Montpellier-Nimes, France
| | - Jean Luc Banos
- Department of Interventional Cardiology, Centre cardiologique du Pays Basque, Bayonne, France
| | - Gael Bouchou
- Department of Interventional Cardiology, Saint Etienne University Hospital, Saint Etienne, France
| | - Clémence Laperche
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Bruno Farah
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Grégoire Rangé
- Department of Interventional Cardiology, Centre Hospitalier, Chartres, France
| | - Thierry Lefèvre
- Department of Interventional Cardiology, Institut Cardio-Vasculaire Paris Sud, Ramsay Générale de Santé, Massy, France
| | - Nicolas Amabile
- Department of Interventional Cardiology, Institut Mutualiste Montsouris, Paris, France
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5
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Abstract
Les lésions calcifiées coronaires ont une incidence croissante dans la pratique quotidienne de l'angioplastie coronaire et sont un des facteurs essentiels des CHIP (High Risk Percutaneous Coronary Intervention). La préparation de la plaque calcifiée est essentielle afin de permettre de bonnes expansion et apposition du stent, deux critères indispensables pour un bon résultat à court et long terme de l'angioplastie coronaire. Depuis 2017, le cathéter C2 Shockwave Medical® dispose d'un marquage CE pour la préparation des lésions coronaires calcifiées natives avant l'implantation de stent par le mécanisme de lithotripsie intravasculaire. Ce système se distingue par sa facilité d'utilisation et un très haut niveau de sécurité procédurale, se positionnant comme un challenger des techniques usuelles de préparation de la plaque calcifiée. L'objectif de cette revue est de se focaliser sur le mécanisme d'action de la lithotripsie intracoronaire, les conditions d'utilisation optimale du device et de synthétiser les données de littérature les plus récentes.
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Affiliation(s)
- Benjamin Honton
- Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
| | - Clemence Laperche
- Department of Interventional Cardiology, Hopital Rangueil, Toulouse, France
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6
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Abstract
Coronary artery calcifications are always challenging scenarios for interventional cardiologists. Calcium content in coronary tree directly correlates with male sex, age, Caucasian ethnicity, diabetes, and chronic kidney disease. Intracoronary imaging is useful and necessary to understand calcific lesion features and plan the best percutaneous coronary intervention strategy. Thus, accurate evaluation of patient and lesion characteristics is crucial. For this reason, definition of calcific arc, length, and thickness can suggest the best procedure before stenting and final optimization. In our modern era, different devices are available and all are surprisingly promising.
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7
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Saito S, Yamazaki S, Takahashi A, Namiki A, Kawasaki T, Otsuji S, Nakamura S, Shibata Y. Intravascular Lithotripsy for Vessel Preparation in Severely Calcified Coronary Arteries Prior to Stent Placement ― Primary Outcomes From the Japanese Disrupt CAD IV Study ―. Circ J 2021; 85:826-833. [DOI: 10.1253/circj.cj-20-1174] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Shigeru Saito
- Department of Cardiology, Shonan-Kamakura General Hospital
| | - Seiji Yamazaki
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital
| | | | - Atsuo Namiki
- Department of Cardiology, JOHAS Kanto-Rosai Hospital
| | | | - Satoru Otsuji
- Department of Cardiology, Higashi-Takarazuka Satoh Hospital
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8
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Doshi R, Thakkar S, Patel K, Majmundar M, Shlofmitz E, Kumar A, Gupta N, Adalja D, Patel HP, Jauhar R, Meraj P. Short term outcomes of rotational atherectomy versus orbital atherectomy in patients undergoing complex percutaneous coronary intervention: a systematic review and meta-analysis. SCAND CARDIOVASC J 2021; 55:129-137. [PMID: 33461347 DOI: 10.1080/14017431.2021.1875139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is one of the paramount hurdles for percutaneous coronary intervention (PCI) since it impedes stent delivery and complete expansion. This study intended to evaluate the short-term clinical and procedural outcomes comparing rotational atherectomy (RA) and orbital atherectomy (OA) in patients with heavily calcified coronary lesions undergoing PCI. Design: This systematic review and meta-analysis included all head-to-head published comparisons of coronary RA versus OA. Procedural endpoints and post-procedural clinical outcomes (30 days/in-hospital), were compared. RevMan 5.3 software was used for data analysis. Results: Seven retrospective observational investigations with a total of 4623 patients, including 3203 patients in the RA group and 1420 patients in the OA group, were incorporated. Compared with OA, the RA group was associated with a higher incidence of myocardial infarction at short-term follow-up (OR: 1.56, 95% CI: 1.07-2.29, p = .02, I2 = 0%). No difference was noted among other short-term post-procedural clinical outcomes including all-cause mortality, target vessel revascularization, or major adverse cardiac events. Among procedural complications, RA was associated with reduced coronary artery dissection and arterial perforation. Increased fluoroscopy time was observed in the RA cohort as compared with OA (MD: 4.78, 95% CI: 2.25-7.30, p = .0002, I2 = 80%). Conclusion: RA was associated with fewer vascular complications, but at a cost of higher incidence of myocardial infarction and higher fluoroscopy time compared with OA, at short term follow-up. OA is a safe and effective alternative for the management of CAC.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA
| | - Samarthkumar Thakkar
- Department of Internal Medicine, Rochester Regional Hospital, Rochester, NY, USA
| | - Krunalkumar Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA, USA
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St John's Medical College Hospital, Bangalore, India
| | - Neelesh Gupta
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, India
| | - Harsh P Patel
- Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA
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9
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Shah M, Najam O, Bhindi R, De Silva K. Calcium Modification Techniques in Complex Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2021; 14:e009870. [PMID: 33441017 DOI: 10.1161/circinterventions.120.009870] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous coronary intervention is the most common mode of revascularization and is increasingly undertaken in high-risk subsets, including the elderly. The presence of coronary artery calcification is increasingly observed and significantly limits technical success. The mechanisms for this are multi-factorial, including increased arterial wall stiffness and impaired delivery of devices, leading to suboptimal stent delivery, deployment, and expansion which are harbingers for increased risk of in-stent restenosis and stent thrombosis. Although conventional balloon pretreatment techniques aim to mitigate this risk by modifying the lesion before stent placement, many lesions remain resistant to conventional strategies, due to the severity of calcification. There have been several substantial technological advancements in calcium modification methods in recent years, which have allowed improved procedural success with low periprocedural complication rates. This review will summarize the current adjunctive modification technologies that can be employed to improve technical outcomes in percutaneous coronary intervention in calcific disease and the evidence supporting these tools.
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Affiliation(s)
- Mohammed Shah
- University College London, United Kingdom (M.S., O.N.)
| | - Osman Najam
- University College London, United Kingdom (M.S., O.N.)
| | | | - Kalpa De Silva
- St. Thomas' Hospital, Guy's & St. Thomas' NHS Foundation Trust, King's College London, United Kingdom (K.D.S.)
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10
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Fan LM, Tong D, Mintz GS, Mamas MA, Javed A. Breaking the deadlock of calcified coronary artery lesions: A contemporary review. Catheter Cardiovasc Interv 2021; 97:108-120. [PMID: 32865328 DOI: 10.1002/ccd.29221] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023]
Abstract
Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse long-term clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an A-M-A-S-A algorithm in managing calcified coronary lesions.
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Affiliation(s)
- Lampson M Fan
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - David Tong
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gary S Mintz
- Department of Cardiology, Cardiovascular Research Foundation, New York, New York
| | - Mamas A Mamas
- Department of Cardiology, University hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Ahmed Javed
- Department of Cardiology, Freeman Hospital, Newcastle-upon-Tyne, UK
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11
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Beohar N, Kaltenbach LA, Wojdyla D, Pineda AM, Rao SV, Stone GW, Leon MB, Sanghvi KA, Moses JW, Kirtane AJ. Trends in Usage and Clinical Outcomes of Coronary Atherectomy. Circ Cardiovasc Interv 2020; 13:e008239. [DOI: 10.1161/circinterventions.119.008239] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Adjunctive coronary atherectomy (CA) can be utilized in treating severely calcified coronary lesions; however, the temporal trends, patient selection, and variation in use of CA have not been well described. We sought to assess the trends in usage, interhospital variability, and outcomes with CA among patients undergoing percutaneous coronary intervention (PCI).
Methods:
All patients undergoing PCI in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2016 (N=3 864 377) were analyzed based on utilization of either rotational or orbital CA. Intervals using date of index CA grouped into 2009 Q3 to 2010, 2011 to 2012, 2013 to 2014, and 2015 to 2016 and hospital-level quartiles based on annual CA volumes were evaluated. The primary outcome measure was in-hospital major adverse cardiac events defined as a composite of all-cause mortality, periprocedural myocardial infarction, or stroke. Independent variables associated with outcomes were determined.
Results:
CA represented 1.7% (n=65 033) of the total PCI volume. Among hospitals performing PCI (n=1672), 577 (34.5%) did not perform any CA. Patients treated with CA were elderly, more often male, and had a history of diabetes, prior myocardial infarction, PCI, and coronary artery bypass grafting. The utilization of CA increased from 1.1% in Q3 2009 to 3.0% in Q4 of 2016 (5% quarterly increase in odds of CA; OR [95% CI], 1.05 [1.04–1.06],
P
<0.001). Among patients undergoing CA, there was a temporal decline in major adverse cardiac events (0.98 [0.97–0.99],
P
<0.001) and myocardial infarction (0.97 [0.96–0.98],
P
<0.001). In adjusted analyses, increasing hospital CA volume was associated with lower mortality (0.85 [0.76–0.96],
P
=0.01) and lower rates of PCI failure or complication requiring coronary artery bypass grafting (0.67 [0.56–0.79],
P
<0.001) but was associated with small increase in coronary perforation (1.18 [1.04–1.35],
P
<0.01).
Conclusions:
Although CA is performed infrequently, its use has increased over time. After accounting for potential confounders, higher CA volume was associated with lower risk of major adverse events counterbalanced by small risk of coronary perforation.
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Affiliation(s)
- Nirat Beohar
- NewYork-Presbyterian Hospital/Columbia University Medical Center (N.B., M.B.L., J.W.M., A.J.K.)
- Mount Sinai Medical Center, Miami Beach, FL (N.B.)
| | | | - Daniel Wojdyla
- Duke Clinical Research Institute, Durham, NC (L.A.K., D.W., S.V.R.)
| | - Andrés M. Pineda
- University of Florida College of Medicine, Jacksonville, FL (A.M.P.)
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC (L.A.K., D.W., S.V.R.)
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.W.S., M.B.L., J.W.M., A.J.K.)
| | - Martin B. Leon
- NewYork-Presbyterian Hospital/Columbia University Medical Center (N.B., M.B.L., J.W.M., A.J.K.)
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.W.S., M.B.L., J.W.M., A.J.K.)
| | | | - Jeffrey W. Moses
- NewYork-Presbyterian Hospital/Columbia University Medical Center (N.B., M.B.L., J.W.M., A.J.K.)
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.W.S., M.B.L., J.W.M., A.J.K.)
| | - Ajay J. Kirtane
- NewYork-Presbyterian Hospital/Columbia University Medical Center (N.B., M.B.L., J.W.M., A.J.K.)
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.W.S., M.B.L., J.W.M., A.J.K.)
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12
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Is crossability of the classic crown with the glide assist superior to the micro crown in the Diamondback 360® coronary orbital atherectomy system? Cardiovasc Interv Ther 2020; 35:361-370. [PMID: 31939066 DOI: 10.1007/s12928-020-00640-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
The Diamondback 360® coronary orbital atherectomy system (OAS) can safely debulk calcified lesions by pullback of the crown, if the crown is advanced to the distal of the lesion. The aim of this study was to compare crossability with two types of crown in OAS. Thirty-six consecutive severely calcified lesions in 33 patients who underwent percutaneous coronary intervention with the coronary OAS were included. The micro crown was used in 18 consecutive lesions from April 2018 to February 2019, and the classic crown with the glide assist was used in 18 consecutive lesions from March 2019 to August 2019. Good crossability was defined as the ability to cross the lesion before orbital atherectomy or to cross the lesion with a first session of orbital atherectomy. We also tried to elucidate whether the crown could cross the lesion without using the glide assist in 13 consecutive lesions at the end of the classic crown cases. Good crossability was more often observed in cases with the classic crown (17 of 18 lesions, 94%) than the micro crown (6 of 18 lesions, 33%) (P < 0.001). In 13 consecutive lesions at the end of the classic crown cases, the crown could cross the lesion in 4 lesions (31%) without use of the glide assist or orbital atherectomy, and in 11 lesions (85%) with only use of the glide assist (P = 0.005). The classic crown with the glide assist is superior to the micro crown in terms of crossability for severely calcified lesions.
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13
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Shlofmitz E, Jeremias A, Shlofmitz R, Ali ZA. Lesion Preparation with Orbital Atherectomy. ACTA ACUST UNITED AC 2019; 14:169-173. [PMID: 31867064 PMCID: PMC6918479 DOI: 10.15420/icr.2019.20.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/01/2019] [Indexed: 01/15/2023]
Abstract
Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.
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Affiliation(s)
| | - Allen Jeremias
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US
| | | | - Ziad A Ali
- St Francis Hospital, Roslyn New York NY, US.,Cardiovascular Research Foundation New York NY, US.,Columbia University Medical Center New York, NY, US
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14
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Abstract
Successful percutaneous coronary intervention (PCI) can be challenging in the presence of heavily calcified lesions. Severely calcified lesions are associated with worse clinical outcomes. Recognition of calcification is important before stenting to ensure adequate stent expansion can be attained. Orbital atherectomy is a safe and effective method to ablate calcified plaque. Lesion preparation through plaque modification with orbital atherectomy before stent implantation can help to optimize the results of PCI in these complex lesions.
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Affiliation(s)
- Evan Shlofmitz
- MedStar Washington Hospital Center, 110 Irving Street, Suite 4B1, Washington, DC 20010, USA
| | - Richard Shlofmitz
- St. Francis Hospital- The Heart Center, 100 Port Washington Boulevard, Suite 105, Roslyn, NY 11576, USA
| | - Michael S Lee
- UCLA Medical Center, 100 Medical Plaza Suite 630, Los Angeles, CA 90095, USA.
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15
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Percutaneous Left Main Coronary Intervention: A Review of Plaque Modification in Left Main Percutaneous Coronary Intervention. J Clin Med 2018; 7:jcm7070180. [PMID: 30041422 PMCID: PMC6068647 DOI: 10.3390/jcm7070180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022] Open
Abstract
Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based on individual patient characteristics. Since the LMCA is the largest artery in the coronary tree, plaque volume and calcification is greater than other coronary segments and often extends to the distal bifurcation segment. In LMCA bifurcation lesions, larger minimal stent area is strongly associated with better outcome in the DES era. Plaque modification strategies such as rotational, orbital, or laser atherectomy are effective mechanisms to reduce plaque volume and alter compliance, facilitating stent delivery and stent expansion. We present a case of a calcified, medina class 1,1,1 LMCA lesion where intravascular ultrasound (IVUS) and orbital atherectomy were employed for optimal results. In this context, we review the evidence of plaque modification devices and the rationale for their use in unprotected left main PCI.
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Manunga J. Bifurcated Stent Technique: A Viable Option for Treatment of Patients With Unusual Anatomy Presenting With Combined Chronic Mesenteric Ischemia and Diffuse Ischemic Gastric Ulcers. Vasc Endovascular Surg 2017; 52:66-69. [DOI: 10.1177/1538574417736691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of chronic mesenteric ischemia has evolved over the last two decades. Endovascular therapy is now the treatment of choice for patients with lesions amenable to such an approach. Open revascularization remains the standard of care but is frequently being reserved for lesions containing intraluminal thrombus or severe calcification. In most cases, celiac axis (CA) stenting is not needed since revascularization of the superior mesenteric artery (SMA) alone results in symptomatic resolution. This report describes a case of a patient with chronic mesenteric ischemia and diffuse gastric ulcers found to have a common origin of the SMA and CA that was treated endovascularly using a bifurcated stent technique.
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Affiliation(s)
- Jesse Manunga
- Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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17
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Shlofmitz E, Martinsen BJ, Lee M, Rao SV, Généreux P, Higgins J, Chambers JW, Kirtane AJ, Brilakis ES, Kandzari DE, Sharma SK, Shlofmitz R. Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert Rev Med Devices 2017; 14:867-879. [DOI: 10.1080/17434440.2017.1384695] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Brad J. Martinsen
- Department of Clinical and Scientific Affairs, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Michael Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Sunil V. Rao
- Duke Clinical Research Institute, Durham, NC, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Morristown Medical Center, Morristown, NJ, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Canada
| | - Joe Higgins
- Department of Engineering, Cardiovascular Systems, Inc., St. Paul, MN, USA
| | - Jeffrey W. Chambers
- Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, USA
| | - Ajay J. Kirtane
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | | | - Samin K. Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Richard Shlofmitz
- Department of Cardiology, St. Francis Hospital-The Heart Center, Roslyn, NY, USA
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18
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Experimental investigation of the abrasive crown dynamics in orbital atherectomy. Med Eng Phys 2016; 38:639-647. [DOI: 10.1016/j.medengphy.2016.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/26/2016] [Accepted: 04/03/2016] [Indexed: 01/02/2023]
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19
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Sotomi Y, Shlofmitz RA, Colombo A, Serruys PW, Onuma Y. Patient Selection and Procedural Considerations for Coronary Orbital Atherectomy System. Interv Cardiol 2016; 11:33-38. [PMID: 29588702 PMCID: PMC5808671 DOI: 10.15420/icr.2015:19:2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/10/2016] [Indexed: 12/14/2022] Open
Abstract
Despite advances in technology, percutaneous coronary intervention (PCI) of severely calcified coronary lesions remains challenging. Rotational atherectomy is one of the current therapeutic options to manage calcified lesions, but has a limited role in facilitating the dilation or stenting of lesions that cannot be crossed or expanded with other PCI techniques due to unfavourable clinical outcome in long-term follow-up. However the results of orbital atherectomy presented in the ORBIT I and ORBIT II trials were encouraging. In addition to these encouraging data, necessity for sufficient lesion preparation before implantation of bioresorbable scaffolds lead to resurgence in the use of atherectomy. This article summarises currently available publications on orbital atherectomy (Cardiovascular Systems Inc.) and compares them with rotational atherectomy.
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Affiliation(s)
- Yohei Sotomi
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Yoshinobu Onuma
- ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Chambers JW, Behrens AN, Martinsen BJ. Atherectomy Devices for the Treatment of Calcified Coronary Lesions. Interv Cardiol Clin 2016; 5:143-151. [PMID: 28582200 DOI: 10.1016/j.iccl.2015.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.
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Affiliation(s)
- Jeffrey W Chambers
- Metropolitan Heart and Vascular Institute, The Heart Center, Mercy Hospital, Suite 120, 4040 Coon Rapids Boulevard, Minneapolis, MN 55433, USA.
| | - Ann N Behrens
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
| | - Brad J Martinsen
- Science & Research Department, Cardiovascular Systems, Inc, 1225 Old Highway 8 NW, St Paul, MN 55112, USA
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Farag M, Costopoulos C, Gorog DA, Prasad A, Srinivasan M. Treatment of calcified coronary artery lesions. Expert Rev Cardiovasc Ther 2016; 14:683-90. [PMID: 26924773 DOI: 10.1586/14779072.2016.1159513] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavily calcified coronary plaques represent a complex lesion subset and a challenge to the interventional cardiologist, as they are often resistant to simple plaque modification with conventional balloon angioplasty. Inadequate plaque modification can lead to stent underdeployment, which itself predisposes to in-stent restenosis and stent thrombosis. Over the years, a number of mechanical devices ranging from modified angioplasty balloons to atherectomy devices have become available in order to tackle such lesions. Here we review these devices concentrating on the evidence behind their use.
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Affiliation(s)
- Mohamed Farag
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
| | - Charis Costopoulos
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.,b Department of Cardiovascular Medicine , University of Cambridge , Cambridge , UK
| | - Diana A Gorog
- c Faculty of Medicine, National Heart and Lung Institute, Imperial College London , London , UK
| | - Abhiram Prasad
- d Department of Cardiology, St George's University Hospitals NHS Trust , London , UK
| | - Manivannan Srinivasan
- a Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK
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22
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The clinical and cost burden of coronary calcification in a Medicare cohort: An economic model to address under-reporting and misclassification. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:406-12. [PMID: 26361178 DOI: 10.1016/j.carrev.2015.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/07/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Coronary artery calcification (CAC) is a well-established risk factor for the occurrence of adverse ischemic events. However, the economic impact of the presence of CAC is unknown. OBJECTIVES Through an economic model analysis, we sought to estimate the incremental impact of CAC on medical care costs and patient mortality for de novo percutaneous coronary intervention (PCI) patients in the 2012 cohort of the Medicare elderly (≥65) population. METHODS This aggregate burden-of-illness study is incidence-based, focusing on cost and survival outcomes for an annual Medicare cohort based on the recently introduced ICD9 code for CAC. The cost analysis uses a one-year horizon, and the survival analysis considers lost life years and their economic value. RESULTS For calendar year 2012, an estimated 200,945 index (de novo) PCI procedures were performed in this cohort. An estimated 16,000 Medicare beneficiaries (7.9%) were projected to have had severe CAC, generating an additional cost in the first year following their PCI of $3500, on average, or $56 million in total. In terms of mortality, the model projects that an additional 397 deaths would be attributable to severe CAC in 2012, resulting in 3770 lost life years, representing an estimated loss of about $377 million, when valuing lost life years at $100,000 each. CONCLUSIONS These model-based CAC estimates, considering both moderate and severe CAC patients, suggest an annual burden of illness approaching $1.3 billion in this PCI cohort. The potential clinical and cost consequences of CAC warrant additional clinical and economic attention not only on PCI strategies for particular patients but also on reporting and coding to achieve better evidence-based decision-making.
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Généreux P, Lee AC, Kim CY, Lee M, Shlofmitz R, Moses JW, Stone GW, Chambers JW. Orbital Atherectomy for Treating De Novo Severely Calcified Coronary Narrowing (1-Year Results from the Pivotal ORBIT II Trial). Am J Cardiol 2015; 115:1685-90. [PMID: 25910525 DOI: 10.1016/j.amjcard.2015.03.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 12/25/2022]
Abstract
Percutaneous coronary intervention of severely calcified lesions has historically been associated with major adverse cardiac event (MACE) rates as high as 30%. In the ORBIT II (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) trial, treatment of de novo severely calcified lesions with the Diamondback 360° Coronary Orbital Atherectomy System (OAS) resulted in low rates of procedural and 30-day adverse ischemic events. The long-term results from this trial have not been reported. We sought to determine the 1-year outcomes after orbital atherectomy of severely calcified coronary lesions. ORBIT II was a single-arm trial enrolling 443 subjects at 49 US sites with severely calcified lesions usually excluded from randomized trials. OAS utilizes a centrifugal differential sanding mechanism of action for plaque modification prior to stent implantation. After OAS drug-eluting stents were implanted in 88.2% of the patients. The primary safety end point was 30-day MACE, the composite of cardiac death, myocardial infarction, or target vessel revascularization [TVR]. The present analysis reports the 1-year follow-up results from ORBIT II. One-year data were available in 433 of 443 patients (97.7%), with median follow-up time of 16.7 months. The 1-year MACE rate was 16.4%, including cardiac death (3.0%), myocardial infarction (9.7%), and target vessel revascularization (5.9%). The 1-year target lesion revascularization rate was 4.7%, and stent thrombosis occurred in 1 patient (0.2%). Independent predictors of 1-year MACE and target vessel revascularization were diameter stenosis at baseline and the use of bare-metal stents. In patients with severely calcified lesions who underwent percutaneous coronary intervention, the use of OAS was associated with low rates of 1-year adverse ischemic events compared with historical controls. This finding has important clinical implications for the selection of optimum treatment strategies for patients with severely calcified lesions.
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Long-term safety and performance of the orbital atherectomy system for treating calcified coronary artery lesions: 5-Year follow-up in the ORBIT I trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:213-6. [PMID: 25866032 DOI: 10.1016/j.carrev.2015.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE The ORBIT I trial, a first-in-man study, was conducted to evaluate the safety and performance of the orbital atherectomy system (OAS) in treating de novo calcified coronary lesions. METHODS/MATERIALS Fifty patients were enrolled between May and July 2008 based on several criteria, and were treated with the OAS followed by stent placement. The safety and performance of the OAS were evaluated by procedural success, device success, and overall major adverse cardiovascular event (MACE) rates, including cardiac death, myocardial infarction (MI) and need for target lesion revascularization (TLR). Our institution enrolled and treated 33 of the 50 patients and continued follow-up for 5 years. RESULTS Average age was 54 years and 91% were males. Mean lesion length was 15.9 mm. Device success was 100%, and average number of orbital atherectomy devices (OAD) used per patient was 1.3. Stents were placed directly after OAS in 31/32 patients (96.9%). All stents (average stent per lesion 1.1) were successfully deployed with 0.3% residual stenosis. The overall cumulative MACE rate was 6.1% in-hospital, 9.1% at 30 days, 12.1% at 6 months, 15.2% at 2 years, 18.2% at 3 years and 21.2% at 5 years (4 total cardiac deaths). None of the patients had Q-wave MIs. Angiographic complications were observed in 5 patients. No flow/slow flow due to distal embolization was observed. CONCLUSIONS The ORBIT I trial suggests that OAS treatment continues to offer a safe and effective method to change compliance of calcified coronary lesions to facilitate optimal stent placement in these difficult-to-treat patients.
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25
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Rational use of rotational atherectomy in calcified lesions in the drug-eluting stent era: Review of the evidence and current practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:78-83. [DOI: 10.1016/j.carrev.2014.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/15/2022]
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