Outcomes in Elderly Patients With Severely Calcified Coronary Lesions Undergoing Orbital Atherectomy

Lee, Michael S.; Shlofmitz, Evan; Lluri, Gentian; Shlofmitz, Richard

doi:10.1111/joic.12362

Cited by 23 publications

(27 citation statements)

References 17 publications

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“…al. reports their results in elderly patients (>75 years of age) versus non‐elderly and found no difference in angiographic or clinical complications between the two groups . These data suggest that appropriately selected, high risk elderly patients may be safely treated with atherectomy.…”

mentioning

confidence: 91%

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Editorial: The Conundrum of Calcified Coronaries

Grines

Kaplan

Singh

2017

J Interven Cardiology

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mentioning

confidence: 91%

“…These four new studies published in the Journal suggest combined therapy with atherectomy and DES or DCB is safe and effective in the management of calcified lesions.…”

mentioning

confidence: 99%

Editorial: The Conundrum of Calcified Coronaries

Grines

Kaplan

Singh

2017

J Interven Cardiology

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“…The use of orbital atherectomy has been found to be safe and effective in a multicenter registry previously, and new studies have since demonstrated safety in high risk elderly patients . These results offer safe and effective management of calcified lesions with combined approach with atherectomy followed by DES or DCB.…”

Section: Calcified Coronariesmentioning

confidence: 88%

Percutaneous coronary intervention: 2017 in review

Rao

Sheth

Grines

2018

J Interven Cardiology

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In an effort to keep the interventional community up-to-date with the abundant amount of new data, we have selected what we believe to be the most important publications in percutaneous coronary intervention from January 1, 2017 to 2 The overall rate of complete revascularization (CR) was 61.7%.In those patients with CR, there was no difference between CABG or PCI regarding death from any cause as well as composite of death, MI, and stroke at 5 year follow up, even at higher SYNTAX scores.However, compared to CABG with CR, PCI with incomplete revascularization put patients at a significant higher risk for similar endpoints. These studies suggest that the ability to achieve CR should be strongly considered when deciding between CABG and PCI in MVD.As we have learned from contemporary data on revascularization, certain subsets of patients have fared better with one revascularization strategy over another. An observational cohort study of multiple Swedish registries found that in patients with Type 1 diabetes and MVD, first multi-vessel revascularization with PCI was associated with higher risk of cardiac death, MI, and repeat revascularization although with similar all-cause mortality when compared to CABG. 3 This study indicates that CABG may be the preferred strategy in patients with Type 1 diabetes in need of multi-vessel revascularization, and is in agreement with earlier trials showing most of the benefit in patients treated with insulin, but not oral agents.In patients with low or intermediate SYNTAX score, PCI of unprotected left main with everolimus-eluting stents (EES) was shown to be noninferior to CABG with respect to a composite endpoint of death, stroke, and MI at 3 years in the EXCEL trial. 4 Of the 1905 patients randomized during the trial, 1788 patients were also followed for quality of life assessment to fully understand patient's perspective.

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“…[42] At 1-year follow-up, the composite rate of major adverse cardiac and cerebrovascular events occurred in 12.6%, with 4.0% all-cause mortality, 1.8% MI rate and TVR rate of 7.5%. [43]…”

Section: Orbital Atherectomymentioning

confidence: 99%

Lesion Preparation with Orbital Atherectomy

et al. 2019

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Despite significant improvements in stent design, severe coronary calcification continues to impede adequate stent expansion and is associated with worse clinical outcomes. Angiography is limited in its ability to detect and comprehensively characterise calcified plaque. Intravascular imaging provides information on lesion morphology guiding appropriate treatment strategies. Orbital atherectomy allows for lesion preparation of severely calcified plaque prior to stent implantation. Utilising a unique mechanism of action incorporating centrifugal forces, a standard 1.25 mm eccentrically mounted and diamond-coated burr orbits bi-directionally to ablate calcified plaque. Lesion preparation with orbital atherectomy allows for modification of calcified plaque to facilitate stent expansion.

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Outcomes in Elderly Patients With Severely Calcified Coronary Lesions Undergoing Orbital Atherectomy

Cited by 23 publications

References 17 publications

Editorial: The Conundrum of Calcified Coronaries

Editorial: The Conundrum of Calcified Coronaries

Percutaneous coronary intervention: 2017 in review

Lesion Preparation with Orbital Atherectomy

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