Difference between antegrade and retrograde orbital atherectomy system debulking using an artificial pulsatile heart...

Area of Science:

• Cardiovascular Interventions
• Medical Device Technology
• Biomedical Engineering

Background:

• Severe calcified lesions necessitate effective debulking devices.
• Orbital Atherectomy System (OAS) features unique forward and backward burr movement.
• Limited research exists on comparing antegrade versus retrograde OAS ablation styles.

Purpose of the Study:

• To evaluate differences in ablation style between antegrade and retrograde OAS usage.
• To assess the impact of ablation direction on debulking effectiveness using an artificial heart model and OCT.

Main Methods:

• Utilized the HEARTROID® artificial pulsatile heart model with a simulated calcified lesion.
• Performed only-antegrade and only-retrograde OAS ablations on five lesions each.
• Employed Optical Coherence Tomography (OCT) for pre-ablation, post-low speed, and post-high speed debulking assessments.

Main Results:

• Analysis of 91 debulked cross-sections revealed significant differences between groups.
• The antegrade group showed a significantly larger debulked area (0.76 mm² vs. 0.53 mm²) and depth (0.76 mm vs. 0.53 mm) after high-speed debulking (p < 0.001).
• No significant differences were observed in debulked bias or width between the antegrade and retrograde groups.

Conclusions:

• Antegrade OAS debulking resulted in a larger ablated area compared to retrograde debulking.
• The increased cutting depth in the antegrade approach contributes to greater debulking effectiveness.
• Findings suggest antegrade OAS may be superior for achieving more comprehensive debulking in calcified lesions.