Advantages of Orbital Atherectomy: A Case Series

Severe coronary calcification poses a significant challenge during percutaneous coronary intervention. Rotational atherectomy is widely used for calcium ablation because of its efficacy, cost-effectiveness and availability. However, orbital atherectomy (OA), with its unique design and mechanism, is the treatment of choice in certain subsets of calcific lesions. Through a case-based approach, we highlighted the unique advantages of OA in modifying calcified lesions. We illustrated three cases with heavily calcified coronary arteries where OA had to be chosen in preference to other calcium modification techniques. We also included imaging evidence to demonstrate the efficacy of OA in calcium modification. Calcific coronary lesions need a multi-pronged approach for optimal management. In certain situations like a mismatch in size between the main vessel and side branch, eccentric calcium with unfavorable wire bias and calcium in close proximity to a stented segment, OA can be used to successfully modify the calcium with lesser risk of complications.