Outcomes after Atherectomy Treatment of Severely Calcified Coronary Bifurcation Lesions: A Single Center Experience

Chambers, Jeffrey W.; Warner, Charles Dudley; Cortez, Josh; Behrens, Ann N.; Wrede, Dylan; Martinsen, Brad J.

doi:10.1016/j.carrev.2018.08.017

Cited by 20 publications

(10 citation statements)

References 15 publications

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“…Plaque shift or carina shift are the likely mechanism for side-branch compromise/closure after main vessel intervention [80,81]. Bifurcation lesions are listed as a warning on the Instructions For Use (IFU) when exhibiting excessive tortuosity and were excluded from the ORBIT II trial; however, since the commercial release of the product in October of 2013, many bifurcation lesions have been successfully treated [82]. When treating bifurcating lesions that do not create a tortuous path for the device, the guide may require upsizing to a 7-Fr system.…”

Section: Bifurcation Lesionsmentioning

confidence: 99%

Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

Shlofmitz

Martinsen

Lee

et al. 2017

Expert Review of Medical Devices

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The presence of severe coronary artery calcification is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with non-calcified lesions. Incorporating orbital atherectomy (OAS) for effective preparation of severely calcified lesions can help maximize the benefits of PCI by attaining maximal luminal gain (or stent expansion) and improve long-term outcomes (by reducing need for revascularization). Areas covered: In this manuscript, the prevalence, risk factors, and impact of coronary artery calcification on PCI are reviewed. Based on current data and experience, the authors review orbital atherectomy technique and best practices to optimize lesion preparation. Expert Commentary: The coronary OAS is the only device approved for use in the U.S. as a treatment for de novo, severely calcified coronary lesions to facilitate stent delivery. Advantages of the device include its ease of use and a mechanism of action that treats bi-directionally, allowing for continuous blood flow during treatment, minimizing heat damage, slow flow, and subsequent need for revascularization. The OAS technique tips reviewed in this article will help inform interventional cardiologists treating patients with severely calcified lesions.

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Section: Bifurcation Lesionsmentioning

confidence: 99%

Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

Shlofmitz

Martinsen

Lee

et al. 2017

Expert Review of Medical Devices

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“…Statistical analyses were performed using the Review Manager, v. 5.3 (The Cochrane Collaboration, London, United Kingdom). RESULTS Six observational studies [9][10][11][12][13][14] comparing OA with RA were included in the analysis reporting outcomes of 1590 patients treated with RA and 721 with OA. The PRISMA flow chart describing the study selection process and PRISMA checklist are available in Supplementary material, Figure S1 and Table S1, respectively.…”

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confidence: 99%

In‑hospital outcomes of rotational versus orbital atherectomy during percutaneous coronary intervention: a meta‑analysis

et al. 2019

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“…transient TIMI-2 flow only just after RA) as well as severe slow flow. The incidence of slow flow during RA varies widely from 2.7 to over 20%, depending on the definition, timing of judgement, and the length of target lesion 40 – 42 . Our incidence of slow flow in PCI with RA was relatively high as compared to literatures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching

Mizuno

Sakakura

Jinnouchi

et al. 2021

Sci Rep

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Complications such as slow flow are frequently observed in percutaneous coronary intervention (PCI) with rotational atherectomy (RA). However, it remains unclear whether the high incidence of slow flow results in the high incidence of periprocedural myocardial infarction (PMI), reflecting real myocardial damage. The aim of this study was to compare the incidence of PMI between PCI with versus without RA using propensity score-matching. We included 1350 elective PCI cases, which were divided into the RA group (n = 203) and the non-RA group (n = 1147). After propensity score matching, the matched RA group (n = 190) and the matched non-RA group (n = 190) were generated. The primary interest was to compare the incidence of PMI between the matched RA and non-RA groups. Before propensity score matching, the incidence of slow flow and PMI was greater in the RA group than in the non-RA group. After matching, the incidence of slow flow was still greater in the matched RA group than in the matched non-RA group (16.8% vs. 9.5%, p = 0.048). However, the incidence of PMI was similar between the matched RA and matched non-RA group (7.4% vs. 5.3%, p = 0.528, standardized difference: 0.086). In conclusion, although use of RA was associated with greater risk of slow flow, use of RA was not associated with PMI after a propensity score-matched analysis. The fact that RA did not increase the risk of myocardial damage in complex lesions would have an impact on revascularization strategy for severely calcified coronary lesions.

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Outcomes after Atherectomy Treatment of Severely Calcified Coronary Bifurcation Lesions: A Single Center Experience

Cited by 20 publications

References 15 publications

Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

In‑hospital outcomes of rotational versus orbital atherectomy during percutaneous coronary intervention: a meta‑analysis

Comparison of the incidence of periprocedural myocardial infarction between percutaneous coronary intervention with versus without rotational atherectomy using propensity score-matching

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