Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography

Abstract

Objectives We sought to assess plaque modification and stent expansion following orbital atherectomy (OA) for calcified lesions using optical coherence tomography (OCT). Background The efficacy of OA for treating calcified lesions is not well studied, especially using intravascular imaging in vivo. Methods OCT was performed preprocedure, post‐OA, and post‐stent (n = 58). Calcium modification after OA was defined as a round, concave, polished calcium surface. Calcium fracture was complete discontinuity of calcium. Results Comparing pre‐ vs post‐OA OCT (n = 29), calcium area was significantly decreased post‐OA (from 3.4 mm2 [2.4–4.7] to 2.9 mm2 [1.9–3.9], P < 0.001). Poststent percent calcium fracture (calcium fracture length/calcium length) correlated with post‐OA percent calcium modification (calcium modification length/calcium length) (r = 0.31, P = 0.01). Among 75 calcium fractures in 35 lesions, maximum calcium thickness at the fracture site was greater with vs without calcium modification (0.58 mm [0.50–0.66] vs 0.45 mm [0.38–0.52], P = 0.003). Final optimal stent expansion, defined as minimum stent area ≥6.1 mm2 or stent expansion ≥90% (medians of this cohort) at the maximum calcium angle site, was observed in 41 lesions. Larger post‐OA lumen area (odds ratio 2.64; 95% CI 1.21–5.76; P = 0.02) and the presence of calcium fracture (odds ratio 6.77; 95% CI 1.25–36.6; P = 0.03) were independent predictors for optimal stent expansion. Conclusions Calcium modification by OA facilitates poststent calcium fracture even in thick calcium. Greater calcium modification correlated with greater calcium fracture, in turn resulting in better stent expansion.

Feasibility and safety of orbital atherectomy for the treatment of in‐stent restenosis secondary to stent under‐expansion

“…11,12 Mechanisms of action of OA in ISR due to SU may be (a) direct ablation of the calcium, (b) direct stent ablation as demonstrated by electron microscopy and intracoronary imaging (Figures 3 and 4), (c) mechanical injury of calcium outside the stent commonly known as lateral "jackhammering," and (d) thermal injury. OA has the ability to fracture calcium as shown in previous studies 15 as well as ablate stent strut and therefore achieve significant luminal gain to allow for expansion of the undilatable segment. OA, particularly at high speed (120,000 rpm), allows for ablation of up to 3 mm lumen diameter and may, therefore, be the preferred atherectomy modality in the treatment of SU in larger vessels.…”

Sex-Specific Outcomes After Coronary Intravascular Lithotripsy: A Patient-Level Analysis of the Disrupt CAD Studies

“…7 Lesion preparation improves compliance of calcified lesions, allowing better stent expansion and improved long-term outcomes. 22,30 Although atheroablative strategies have been the standard approach for calcified lesion preparation, they are not universally available and are associated particularly in women with an increased risk of procedural complications, including vessel perforation, abrupt vessel closure, and no reflow due to platelet activation and particulate embolization. 9,10,31 In a retrospective analysis of 765 patients who underwent rotational atherectomy at a large referral center, periprocedural complications were significantly higher in women than those in men, including higher rates of coronary dissection (OR 3.78; 95% CI 1.42-10.05, P ¼ .004), cardiac tamponade (OR 5.14; 95% CI 1.03-25.64, P ¼ .026), and BARC 2 or greater bleeding (OR 2.37; 95% CI 1.07-5.23, P ¼ .028) and a higher incidence of MACE at a median of 4.7 years of follow-up (HR 1.92; 95% CI 1.34-2.77, P < .001).…”

Az orbitális atherectomia kettős hatásmechanizmusa intravaszkuláris ultrahangfelvételeken

“…Ezzel a 1,25 milliméteres eszköz akár nagymértékben különböző lumenátmérőjű erekben is az intima felszínén a kalciumot 2 mikrométer nagyságú partikulumokra csiszolja. Ezzel párhuzamosan a forgásból adódó pulzációs mozgásra is képes amellyel a mélyebben, a mediában lévő összefüggő kalcifikált rétegeket is kisebb lemezekre töri (4). A 80-120 ezres fordulatszámmal haladó gyűrű excentrikus mozgása miatt mindig az ér luminális felszínén halad, az áramlást nem okkludálja, valamint az ér egészséges szakaszait, elasztikus rugalmasságuknál fogva nem károsítja (5).…”