Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes

Abstract

Background: Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. Methods: we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. Results: The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26–36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26–33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). Conclusion: OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD.

Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR)

“…Furthermore, the ROTAXUS trial failed to demonstrate any clinical benefit of rotational atherectomy compared with standard balloon predilatation [ 45 ]. Although data comparing RA and OA are scarce [ 40 , 46 , 47 ], juxtaposing them with the results obtained in our study suggests that OA may have some clinical advantage over RA. This fact may be related to the more favorable mechanism of action of OA—the ability to provide bidirectional passage with additional orbital movement inside the lumen vessel, allowing interaction with deep calcium deposits, reducing the size of debris generated during the ablation process, and providing continuous blood flow through the vessel during the procedure [ 27 ].…”

Rotational Atherectomy, Orbital Atherectomy, and Intravascular Lithotripsy Comparison for Calcified Coronary Lesions

“…It can also modify noncalcified lesions [16]. Studies show a longer procedural time of OA when compared to RA [31]. However, a greater duration of the procedure in OA may be associated with the best practice recommendations, which include a rest time longer than each treatment interval.…”

Clinical Outcomes and Prognostic Factors in Complex, High-Risk Indicated Procedure (CHIP) and High-Bleeding-Risk (HBR) Patients Undergoing Percutaneous Coronary Intervention with Sirolimus-Eluting Stent Implantation: 4-Year Results

“…The abovementioned factors associated with ISR also pose a challenge in CHIP patients to obtain optimal procedural as well as long-term outcomes. In CHIP patients, to obtain the optimal outcome, often, additional interventions are required, such as using rotational atherectomy or orbital atherectomy, which makes the procedures even more difficult and associated with a higher risk of periprocedural complications [ 13 , 14 ]. Moreover, more and more frequently, CHIP patients undergo PCI with the simultaneous use of percutaneous left ventricular assist devices [ 15 , 16 ].…”