Lesion Preparation with Orbital Atherectomy

Shlofmitz, Evan; Jeremias, Allen; Shlofmitz, Richard; Ali, Ziad A.

doi:10.15420/icr.2019.20.r1

Cited by 19 publications

(5 citation statements)

References 53 publications

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“…Similarly, orbital atherectomy PCI was performed by experienced PCI operators who underwent training and obtained the necessary certificates to perform the OA procedures. All OA procedures were performed in accordance with contemporary clinical practice [ 10 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

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

Rola

Kulczycki²,

Barycki

et al. 2023

JCM

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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.

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Section: Methodsmentioning

confidence: 99%

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

Rola

Kulczycki²,

Barycki

et al. 2023

JCM

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“…During the atherectomy procedure, intravascular imaging is helpful for determining the need for additional atherectomy and completion of atherectomy [7]. In particular, as the rotating speed is never displayed during an OA procedure, evaluation of the presence or absence of calcium modi cation is important for evaluating the e cacy of OA [22]. Therefore, during the OA procedure, OFDI could potentially be very useful for determining the calcium modi cation.…”

Section: Discussionmentioning

confidence: 99%

High-definition intravascular ultrasound versus optical frequency domain imaging for the detection of calcium modification and fracture in heavily calcified coronary lesion

Ishida

Oshikiri

Kimura

et al. 2022

Int J Cardiovasc Imaging

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While optical frequency domain imaging (OFDI) can delineate calcium modi cation and fracture, the capability of high-de nition intravascular ultrasound (HD-IVUS) for detecting these remains unclear. This study evaluated the diagnostic accuracy of HD-IVUS for assessing calcium modi cation and fracture as compared to OFDI. MethodsHD-IVUS and OFDI were used during orbital or rotational atherectomy procedures conducted for 21 heavily calci ed coronary lesions in 19 patients. With OFDI assessment used as the gold standard, diagnostic accuracies of HD-IVUS for calcium modi cation and fracture were compared every 1 mm to the matched pre-stenting images (n=1,129). Calcium modi cation, as assessed by OFDI, was de ned as polished and concave-shaped calcium. For HD-IVUS, calcium modi cation was de ned as the presence of reverberation with concave-shaped calcium. In both assessments, the de nition of calcium fracture was de ned as a slit or complete break in the calcium plate. ResultsCalci ed plaque was found in 86.4% of analyzed OFDI images. Calcium modi cation and fracture were detected in 20.6% and 11.0% of detected calci ed plaques. Sensitivity, speci city, positive and negative predictive values of HD-IVUS detection for calcium modi cation and fracture were 54.4%, 97.8%, 86.7%, 89.1% and 86.0%, 94.5%, 58.2%, 96.8%, respectively. Discordance cases between both assessments demonstrated that heterogeneous calcium visualized by OFDI, separated calcium and guide wire artifact can be misdiagnosed. ConclusionDiagnostic accuracies of HD-IVUS for assessing calcium modi cation and fracture were modest as compared to OFDI. These results suggest that OFDI guidance is more feasible during treatment of heavily calci ed coronary lesions versus HD-IVUS guidance.

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“…Additionally, iFR-guided revascularization was noninferior to FFR-guided revascularization for major adverse cardiac events at 1-year follow-up in two separate, large randomized multicenter trials. 8…”

Section: Discussionmentioning

confidence: 99%

Invasive Coronary Physiology Study in Multivessel Coronary Artery Disease

et al. 2022

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Assessment of relationship between the angiographic stenosis severity and the coronary blood flow is complex. Coronary angiography has many limitations that may impair the judgment of stenosis severity and then affect decision-making regarding intervention. Myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) is used for a long time to help clinical decisions of interventions, but has limitations, such as issues with identification of extensive coronary artery disease (CAD). Fractional flow reserve (FFR) is a gold standard index for investigating the physiological significance of a coronary stenosis. The instantaneous wave-free ratio (iFR) is a hyperemia-free measurement and easier method to achieve physiological assessment to measure the severity of coronary stenosis. We present a case of multivessel coronary artery disease (MVCAD) patient who was treated with iFR-guided percutaneous coronary intervention (PCI) and emphasize the importance of physiological assessment in PCI.A 63-year-old male with multiple cardiovascular risk factors came to our center with chief complaint of stable angina since 1 year. He underwent MPI-SPECT and the result showed 2.5% of ischemia burden. Coronary angiography showed MVCAD. Surgical conference decided to do PCI. iFR-guided PCI was performed in this case.Our case highlights the importance of iFR as an important cardiology–physiology-based tool as a guide in management decisions for MVCAD. iFR as an alternative approach to physiological study is noninferior compared with FFR-guided PCI.

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Lesion Preparation with Orbital Atherectomy

Cited by 19 publications

References 53 publications

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

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

High-definition intravascular ultrasound versus optical frequency domain imaging for the detection of calcium modification and fracture in heavily calcified coronary lesion

Invasive Coronary Physiology Study in Multivessel Coronary Artery Disease

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