A State-of-the-Art Review: The Percutaneous Treatment of Highly Calcified Lesions

Bamford, Paul; Collins, Nicholas; Boyle, Andrew

doi:10.1016/j.hlc.2022.08.009

Cited by 5 publications

(5 citation statements)

References 87 publications

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“…Given the complexity of the disease and the high prevalence of ACS cases along with the co-morbidities of the patients recruited in this study, the short-term clinical outcomes (MACE, death, MI, and TLR) in both study groups are equal or superior to many previously reported in the literature [ 34 , 35 , 36 , 37 ]. Considering that RA has shown significant improvement in increasing procedural success rates in the treatment of severely calcified coronary lesions [ 38 ] results of our pilot study suggest that OA in high-risk populations with LMD showed a similar level of safety and efficiency.…”

Section: Discussionmentioning

confidence: 95%

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: Discussionmentioning

confidence: 95%

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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“…Therefore, several dedicated devices have been developed to achieve proper plaque modification. Before orbital atherectomy and ShockWave intravascular lithotripsy entered clinical practice, rotational atherectomy was the most commonly used advanced debulking device [ 25 , 26 ]. While the safety and efficacy of RA have been well documented [ 27 , 28 ], data on OA are still scarce and mostly derived from single-arm, strictly controlled studies [ 29 , 30 , 31 , 32 ] designed to obtain approval for the use of a device in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR)

Rola,

Włodarczak,

Barycki

et al. 2023

JCM

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Background: Coronary calcifications represent a challenging subset for the interventional cardiologist performing percutaneous coronary intervention (PCI) and are well-established risk factors for adverse outcomes. Adequate plaque modification prior to stent implantation is critical to achieve an optimal outcome following PCI. Recently, a novel orbital atherectomy device has been introduced into clinical practice to modify calcified plaques. We evaluated the mid-term safety and efficacy of OA in a high-risk “all-comers” population. Methods: We evaluated 96 consecutive patients with severely calcified coronary lesions who underwent PCI facilitated by the orbital atherectomy device. Results: In-hospital MACCE was 5.2% without target lesion revascularization. At 6-month follow-up, the MACCE rate was 10.4% with a concomitant TLR rate of 1%. Conclusions: Our mid-term data showed good safety and efficacy of orbital atherectomy as a plaque-modifying tool in an all-comers cohort with severely calcified coronary lesions.

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“…The incidence of vascular perforation and stent restenosis is about 3%, and the use of normal saline in coronary arteries may reduce the risk. The method of treatment is limited to when the guide wire of mechanical rotary grinding or microcatheter cannot pass through the lesion 34 . Coronary RA or orbital atherectomy may not have sufficient radial effect on calcification lesions due to the variable movement of the guide wire of mechanical rotary grinding 32 …”

Section: Limitations Of Traditional Treatment Methodsmentioning

confidence: 99%

“…The method of treatment is limited to when the guide wire of mechanical rotary grinding or microcatheter cannot pass through the lesion. 34 Coronary RA or orbital atherectomy may not have sufficient radial effect on calcification lesions due to the variable movement of the guide wire of mechanical rotary grinding. 32 Unlike the traditional balloon-based vessel preparation of high-static barometric pressure, IVL generates acoustic mechanical energy with a low-pressure inflated balloon, reducing the possibility of vascular injury.…”

Section: Limitations Of Traditional Treatment Methodsmentioning

confidence: 99%

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Intravascular lithotripsy: A novel option for severe calcification of coronary artery

Lv,

Li,

Ren

et al. 2023

Clinical Cardiology

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BackgroundSevere coronary artery calcification is associated with low success rate of interventional operation, perioperative adverse cardiac events, and poor prognosis, which is a major problem faced by operators. The existing therapy methods all have inherent limitations, such as unsatisfactory balloon crossability, inadequate balloon dilation, and so on. The emergence of intravascular lithotripsy (IVL) has brought the dawn of the treatment of calcified lesions by using unfocused acoustic pressure waves to fracture calcification in situ. And IVL is the only technology capable of targeting deep calcification.HypothesisIVL may have great clinical application values and potential prospects.MethodBased on the existing clinical evidence of IVL and traditional treatment ways, this review discusses the safety and efficacy of IVL. Combined with clinical practice, the precautions and coping strategies of IVL are analyzed. And the review improves the management algorithm of coronary calcification.ResultsIVL has extremely high safety and effectiveness for severe coronary calcification compared with other ways, and structural improvements of IVL will further expand its value.ConclusionsThe emergence of IVL could set off a revolution in the treatment of coronary artery calcification.

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A State-of-the-Art Review: The Percutaneous Treatment of Highly Calcified Lesions

Cited by 5 publications

References 87 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

Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR)

Intravascular lithotripsy: A novel option for severe calcification of coronary artery

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