Outcomes of rotational atherectomy versus orbital atherectomy for the treatment of heavily calcified coronary stenosis: A systematic review and meta‐analysis

Abstract

Introduction The optimal approach to deal with severe coronary artery calcification (CAC) during percutaneous coronary intervention (PCI) remains ill‐defined. Methods We conducted an electronic database search of all published studies comparing Orbital versus Rotational Atherectomy in patients undergoing PCI. Results Eight observational studies were included in the analysis. Overall, there were no significant differences in Major‐adverse‐cardiac‐events/MACE (OR: 0.81, CI: 0.63–1.05, p = .11), myocardial‐infarction/MI (OR: 0.75, CI: 0.56–1.00, p = .05), all‐cause mortality (OR: 0.82, CI: 0.25–2.64, p = .73) or Target‐vessel‐revascularization/TVR (OR: 0.72, CI: 0.38–1.36, p = .31). However, OA was associated with lower long‐term MACE (1‐year), (OR: 0.66, CI: 0.44–0.99, p = .04), long‐term TVR (OR: 0.40, CI: 0.18–0.89, p = .03), and short‐term MI (in‐hospital and 30‐day) (OR: 0.64, CI: 0.44–0.94, p = .02). OA was associated with more coronary artery dissections (OR: 2.61, CI: 1.38–4.92, p = .003) and device‐related coronary perforations (OR: 2.79, CI: 1.08–7.19, p = .03). There were no differences in cardiac tamponade (OR: 1.78, CI: 0.37–8.69, p = .47). OA was noted to have significantly lower fluoroscopy time (MD: −3.96 min, CI: −7.67, −0.25; p = .04) compared to RA. No significant difference was noted in terms of contrast volume between the two groups (OR: −4.35 ml, CI: −14.52, 23.22; p = .65). Conclusion Although there was no difference in overall MACE, MI, all‐cause mortality and TVR, OA was associated with lower long‐term MACE and short‐term MI. OA is associated with lower fluoroscopy time but higher rates of coronary artery dissection and coronary perforation.

Contemporary Interventional Approach to Calcified Coronary Artery Disease

“…A meta-analysis including 8 observational trials and a total of 4,332 patients demonstrated no significant difference in overall all-cause death, major adverse cardiac events, myocardial infarction and target vessel revascularization between rotational and orbital atherectomy. 62) The analysis did, however, report a higher rate of coronary dissections (odds ratio [OR], 2.61, p=0.003) and perforations (OR, 2.79, p=0.03) among patients treated with orbital atherectomy. It is unclear if these risks are device or operator technique related.…”

An algorithmic approach to balloon undilatable coronary lesions

“…Multiple studies have shown good outcomes of OA in de novo coronary lesions (Table 2). [25][26][27] In a meta-analysis of 8 studies (4332 patients) comparing RA with OA, 28 compared with nonatherectomy patients, which may be associated with higher rates of vascular complications, major bleeding, and acute kidney injury. 29 Slow-flow/no-reflow and burr entrapment are other complications associated with RA in particular, but their incidence has decreased over time.…”

“…In a meta‐analysis of 8 studies (4332 patients) comparing RA with OA, 28 OA was associated with lower long‐term (1 year) MACE (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.44, 0.99; p = 0.04), long‐term target‐vessel revascularization (OR: 0.40; 95% CI: 0.18, 0.89; p = 0.03), and short‐term (in‐hospital and 30‐day) myocardial infarction (OR: 0.64; 95% CI: 0.44, 0.94; p = 0.02). On the other hand, OA was associated with more angiographic complications, including coronary artery dissections (OR: 2.61; 95% CI: 1.38, 4.92; p = 0.003) and device‐related coronary perforations (OR: 2.79; 95% CI: 1.08, 7.19; p = 0.03).…”

The dinosaur that still roars

“…Experience has shown that both OA and RA are effective and most patients could be successfully treated using either. Several small, non‐randomized studies comparing RA and OA have been followed by meta‐analyses, the most recent of which is found in this issue of Catheterization and Cardiovascular Interventions 1 …”

“…Khan et al included 3048 RA patients and 1284 OA patients in their meta‐analysis 1 . They defined nine “outcomes of interest” with a total of 17 endpoints (Table 1).…”