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Percutaneous Coronary Intervention of Complex Calcific Coronary Lesions Utilizing Orbital Atherectomy Prior to

Nirat Beohar1, Nafees Mohammed1, Nisharahmed Kherada1

  • 1Mount Sinai Medical Center, Miami Beach, FL, United States of America.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|July 15, 2021
PubMed

Insights

Orbital atherectomy (OA) is a safe and feasible treatment for complex calcific coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR). This approach showed low rates of major adverse cardiac events at 30 days and one year.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery disease (CAD) with severe calcification is common in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
  • Managing CAD in this patient group is complex.
  • Orbital atherectomy (OA) effectively treats calcified coronary lesions, but its use before TAVR (OA PCI + TAVR) is not well-documented.

Purpose of the Study:

  • To evaluate the feasibility, safety, and 1-year outcomes of OA-assisted percutaneous coronary intervention (PCI) prior to TAVR in patients with severe AS and complex calcific CAD.
  • To provide a literature review on atherectomy use in patients with concomitant severe AS and calcific CAD undergoing TAVR.

Main Methods:

  • Retrospective analysis of 18 patients with moderate/severe calcific CAD and AS who underwent staged OA PCI + TAVR.
  • Assessment of 1-year major adverse cardiac events (MACE), including death, target lesion revascularization (TLR), and myocardial infarction (MI).

Main Results:

  • No angiographic complications, stent thrombosis, or stroke events were observed.
  • 30-day MACE rate was 5.6% (no deaths or TLR, 5.6% MI).
  • 1-year MACE rate was 17% (no deaths, 11% TLR, 17% non-Q-wave MI).

Conclusions:

  • OA PCI prior to TAVR is feasible and safe for treating severely calcified coronary lesions.
  • This approach results in acceptable 30-day and 1-year MACE rates in patients with severe AS and complex CAD.
  • OA offers a viable option for managing complex CAD in the TAVR population.
Abstract

Keywords:
Coronary artery diseaseOrbital atherectomyPercutaneous coronary interventionSevere aortic stenosisTranscatheter aortic valve replacement

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