Outcomes Following Orbital Atherectomy for Coronary Calcified Nodules: A Retrospective Single-Center Experience

Coronary calcified nodules (CNs) are a challenging subset of calcific lesions associated with adverse procedural outcomes. While rotational atherectomy (RA) and balloon angioplasty (BA) have been traditionally used, orbital atherectomy (OA) offers a unique mechanism of plaque modification that may be advantageous in the treatment of CNs. Data on OA in CNs remains limited.

To evaluate procedural success, periprocedural safety, in-hospital and long-term outcomes of retrograde OA in the treatment of CNs.

We conducted a retrospective analysis of all patients who underwent OA for angiographically identified coronary calcification between January 1, 2022 and March 31, 2024. A total of 312 patient underwent OA during this period, of whom 57 had a CN identified. Baseline demographics, lesion characteristics, procedural details, and outcomes were assessed. CNs were defined by angiographic or intravascular ultrasound appearance.

The mean age was 71, 71.9% were male, 71.9% had diabetes, 40.3% had CKD and 15.8% had prior coronary artery bypass. The majority of lesions involved the left anterior descending artery (49.1%). Retrograde treatment using a 1.25 mm burr at 80,000 rpms was exclusively used. Angiographic success was achieved in 100% of cases. No perforations or flow-limiting dissections were observed. During an average follow-up of 325.57 ± 233.45 days, there were no cases of early or late stent thrombosis, with one case of very late stent thrombosis. Major adverse cardiac events (MACE) occurred in 5.26% (three patients), comprising myocardial infarction in 3.51% (two patients) and target vessel revascularization in 1.75% (one patient).

In this real-world, single-center, retrospective analysis, OA was safe and effective in treating coronary CNs, achieving high angiographic success with minimal periprocedural complications. These findings support the use of OA as a viable strategy for CNs, though further studies are warranted.