Elastic Material Damage of Rotational Atherectomy and Orbital Atherectomy: An in Vitro Assessment

PurposeRotational atherectomy (RA) and orbital atherectomy (OA) are effective procedures for severe calcified coronary artery disease. Nonetheless, vessel perforation remains an adverse complication of these procedures. This study aimed to evaluate factors affecting elastic material damage caused by RA and OA.MethodsAn in vitro assessment was conducted in which the damage to the rubber latex, an elastic material, after RA was evaluated under various conditions, including burr rotational speed (100,000–220,000 rotations per minute), approaching curve, burr size (1.25 mm, 1.75 mm, and 2.0 mm), and fluid viscosity (water and low-molecular weight dextran). Similarly, the rubber latex damage after OA was evaluated in the same experimental system under various conditions, including crown rotational speed, approaching curve, and fluid viscosity.ResultsIn RA, the rubber latex was damaged at lower rotational speeds (p = 0.003), tighter approaching curves (p < 0.0001), and lower fluid viscosity (p = 0.03). In OA, the rubber latex was generally severely damaged.ConclusionA higher rotational speed, coaxial approach for the wall, and higher viscosity contributed to lesser elastic material damage in RA. The safety mechanism for elastic material in OA proved less effective.

Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization

Purpose: The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes. Materials and Methods: All patients undergoing atherectomy in the 2010–2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared. Results: Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18–5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09–0.95]). Conclusion: Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.