Intravascular imaging-guided treatment of severe coronary artery calcification with orbital atherectomy: A prospective single-centre registry
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1Subang Jaya Medical Centre, Department of Cardiology, Subang Jaya, Malaysia. dryaplokbin@gmail.com.
Insights
Orbital atherectomy (OA) effectively treats severe coronary artery calcification, improving stent delivery and expansion. This study found OA to be a safe and successful procedure with no major adverse cardiovascular events in patients with calcified lesions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Vascular Interventions
Background:
- Severe coronary artery calcification complicates percutaneous coronary intervention (PCI).
- Calcified lesions can impede stent delivery and optimal expansion, leading to suboptimal outcomes.
- Orbital atherectomy (OA) is a technique to address complex calcified lesions.
Purpose of the Study:
- To evaluate the procedural success and safety of orbital atherectomy (OA).
- To assess the efficacy of OA in treating severely calcified coronary lesions.
- To determine the impact of OA on stent implantation and patient outcomes.
Main Methods:
- Prospective, single-center study.
- Utilized intravascular ultrasound (IVUS) or optical coherence tomography (OCT) for lesion characterization and procedural guidance.
- Primary endpoint: successful stent implantation post-OA. Secondary endpoint: in-hospital and 30-day major adverse cardiovascular events (MACE).
Main Results:
- Successfully treated 10 patients with severely calcified lesions using OA.
- Achieved procedural success in all patients, with significant luminal gain (1.3 ± 0.3 mm).
- No in-hospital or 30-day MACE observed; minor complications (slow flow, dissection) were managed successfully.
Conclusions:
- Orbital atherectomy is a feasible and safe option for managing calcified coronary stenosis.
- Intravascular imaging is crucial for assessing calcification, guiding OA, and optimizing stent placement.
- OA effectively disrupts coronary calcification, facilitating successful stent implantation with favorable outcomes.
Introduction:
Coronary artery calcification can lead to suboptimal results when performing coronary angioplasty with conventional techniques. The presence of severe coronary artery calcium increases the complications of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. The purpose of this study was to determine the procedural success and safety of orbital atherectomy (OA) in calcified lesions.
Materials And Methods:
This was a prospective single-centre study regarding the utility of OA in the treatment of calcified coronaries. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was used in all cases to characterise the severity of calcium pre-procedure, guide vessel sizing and assess procedural success. The primary endpoint was procedural success, defined by successful stent implantation following OA treatment. The secondary endpoint was in-hospital and 30-day major adverse cardiovascular event (MACE).
Results:
Ten patients with severely calcified lesions were successfully treated with OA. The primary endpoint was achieved in all patients. All of the lesions were severely calcified with concentric calcium. None of the patients suffered in-hospital or 30-day MACE. The average minimal luminal diameter at baseline was 1.7 ± 0.3 mm and the post- PCI luminal diameter was 3.0 ± 0.3 mm, with a significant luminal gain of 1.3 ± 0.3 mm (p < 0.01). Slow flow during procedure occurred in 2 (20%) cases and dissection occurred in 1 (10%) case during procedure. These were successfully treated with stent delivery to achieve TIMI III flow. There were no cases of stent thrombosis or vessel perforation.
Conclusion:
Our experience demonstrates the feasibility and safety of OA in the management of calcified coronary stenosis. Intravascular imaging is an important adjunct to the use of OA to assess the severity of calcified coronary lesions, success of OA treatment and to aid sizing of the vessel for stent implantation. OA is an effective treatment approach to disrupt coronary calcification, facilitating stent implantation with optimal results. It is a safe procedure with good success rate and low rate of complications.
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