Introduction:
The percutaneous treatment of heavily calcified coronary lesions remains suboptimal and often requires debulking with Rotational Atherectomy (RA) which is often underutilized due to a steep learning curve. Although a novel approach using Orbital Atherectomy (OA) has been introduced, which has an easier set-up and easier learning curve, a comparative assessment of both techniques in real world cohort has not been performed
METHODS:
Retrospective analysis of our prospectively collected database between October 2013 to May 2014 for patients undergoing atherectomy in heavily calcified lesions at our center retrieved 105 OA and 196 RA procedures
RESULTS:
There were no significant differences in patient demographics.The maximal stent diameter was significantly larger in OA vs RA (3.41 mm
2
vs 3.28 mm
2
, p=0.02).There was a trend towards RA showing better Procedural success defined as successful stent deployment with TIMI 3 flow ( 95.9% vs 90.5%, p = 0.06) and Clinical Success which is procedural success without death, stroke or CABG ( 95.9% vs 90.5%, p = 0.06). Two cases of failed initial OA underwent successful RA. Procedural complications (≥ grade 3 dissection, side branch closure, perforation, slow flow/no flow or vessel closure), In-hospital MACE (a composite of death, stroke, CABG or CKMB>5X), 30 day readmission rates and 30 day MACE were not statistically significant[See Table 1 and Figure 1].
CONCLUSION:
OA demonstrated a similar safety and efficacy profile to RA with a trend towards lower procedural success but comparable complications and 30 day outcomes, suggesting OA may serve as an alternative to RA in PCI of heavily calcified lesions.
Intracoronary Lithoplasty in Percutaneous Treatment of Challenging Calcified Coronary Lesions
