One Year Outcomes of Orbital versus Rotational Atherectomy for the Treatment of Heavily Calcified Coronary Disease

Hajj, Milad El; Hill, Andrew; Hajj, Stephanie El; Staub, Spenser; Fernandes, Valerian; Maran, Anbukarasi

doi:10.37532/fmic.2020.12(2).647

Cited by 3 publications

(5 citation statements)

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“…Eight studies involving a total of 4,332 patients were selected for final analysis. All the studies were published between years 2010 to 2020 and included 3,048 patients in the RA arm and 1,284 patients in the OA arm 9‐15 . The baseline study characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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

Khan

Murtaza

Khalid

et al. 2020

Cathet Cardio Intervent

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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.

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Section: Resultsmentioning

confidence: 99%

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

Khan

Murtaza

Khalid

et al. 2020

Cathet Cardio Intervent

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“…According to the data, there were no significant differences in the one-year outcome among individual methods. After one year, MACE occurred in an average of 15% of patients who underwent RA (with a range of 13.2% to 26% depending on the study) [76,93,94]. Similar outcomes were observed in patients who underwent OA, with a mean one-year MACE rate of 14.4% (11% to 16.4%) [94][95][96].…”

Section: Long-term Outcomesmentioning

confidence: 59%

“…In terms of RA, in the Euro4C Group multicenter European study, which included 966 patients, the MACE rate was relatively low at 13.2% [93]. A study by Milad El Hajj et al conducted at a single center reported a relatively high MACE rate of 26% [94]. It included a small number of patients and had a limited impact on the overall outcome of methods such as RA, but the results of the procedure may have depended on the hospital performing the intervention.…”

Section: Long-term Outcomesmentioning

confidence: 99%

“…After one year, MACE occurred in an average of 15% of patients who underwent RA (with a range of 13.2% to 26% depending on the study) [76,93,94]. Similar outcomes were observed in patients who underwent OA, with a mean one-year MACE rate of 14.4% (11% to 16.4%) [94][95][96]. An insignificantly lower MACE rate was observed in patients who underwent IVL, with an average of 13.2% (ranging from 9.4% in Japan to 13.8% in the US and Europe) [60,66].…”

Section: Long-term Outcomesmentioning

confidence: 99%

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Rotational Atherectomy, Orbital Atherectomy, and Intravascular Lithotripsy Comparison for Calcified Coronary Lesions

Florek,

Bartoszewska,

Biegała

et al. 2023

JCM

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In order to improve the percutaneous treatment of coronary artery calcifications (CAC) before stent implantation, methods such as rotational atherectomy (RA), orbital atherectomy (OA), and coronary intravascular lithotripsy (IVL) were invented. These techniques use different mechanisms of action and therefore have various short- and long-term outcomes. IVL employs sonic waves to modify CAC, whereas RA and OA use a rapidly rotating burr or crown. These methods have specific advantages and limitations, regarding their cost-efficiency, the movement of the device, their usefulness given the individual anatomy of both the lesion and the vessel, and the risk of specified complications. This study reviews the key findings of peer-reviewed articles available on Google Scholar with the keywords RA, OA, and IVL. Based on the collected data, successful stent delivery was assessed as 97.7% for OA, 92.4% for IVL, and 92.5% for RA, and 30-day prevalence of MACE (Major Adverse Cardiac Events) in OA—10.4%, IVL—7.2%, and RA—5%. There were no significant differences in the 1-year MACE. Compared to RA, OA and IVL are cost-effective approaches, but this is substantially dependent on the reimbursement system of the particular country. There is no standard method of CAC modification; therefore, a tailor-made approach is required.

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“…44,45 The limited randomized data that compare RA and OA indicate that both modalities are comparable regarding both safety and efficacy, and the choice is down to operator preference and device availability (Supplementary Table 1). 46…”

Section: Orbital Atherectomymentioning

confidence: 99%

Management of Calcified Coronary Lesions

Al-Shaibi,

Bharadwaj,

Mathur

et al. 2024

US Cardiol

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With an aging population, coronary calcification is increasingly encountered in modern day interventional practice. Unfortunately, it is associated with lower procedural success and higher rates of periprocedural complications, such as failure to deliver stents, perforations, dissections, and other major adverse cardiac events. Furthermore, suboptimal stent deployment in the setting of severe calcification is associated with both short- and long-term major adverse cardiac events, including stent thrombosis, MI, in-stent restenosis, and target lesion revascularization. A variety of treatment options for these lesions exist, including specialized balloons, atherectomy, and intravascular lithotripsy. While there is currently no universally accepted algorithm for choosing between these treatment strategies, several different algorithms exist, and the optimization of these treatment regimens will continue to evolve in the coming years. This review aims to provide insights on the different therapeutic modalities and an understanding of the current body of evidence.

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One Year Outcomes of Orbital versus Rotational Atherectomy for the Treatment of Heavily Calcified Coronary Disease

Cited by 3 publications

References 0 publications

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

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

Rotational Atherectomy, Orbital Atherectomy, and Intravascular Lithotripsy Comparison for Calcified Coronary Lesions

Management of Calcified Coronary Lesions

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