Orbital atherectomy versus rotational atherectomy: A systematic review and meta-analysis

Goel, Sunny; Pasam, Ravi Teja; Chava, Srilekha; Gotesman, Joseph; Sharma, Abhishek; Malik, Bilal; Frankel, Robert; Shani, Jacob; Gidwani, Umesh; Latib, Azeem

doi:10.1016/j.ijcard.2019.12.037

Cited by 23 publications

(8 citation statements)

References 26 publications

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“…The bidirectional ablation ability with the OA, combined with the small crown size, minimizes the risk of crown entrapment. In our analysis, OA was associated with a higher risk of coronary perforation and pericardial tamponade, which was not previously detected in studies comparing the two modalities [16,17]. These studies, however, demonstrated a strong trend towards a higher risk of perforation with OA but were not powerful enough to show statistical significance with such a rare clinical event [17].…”

Section: Discussioncontrasting

confidence: 70%

“…Moreover, the ViperWire is easier to use for primary lesion crossing than the ROTA-Wire, which requires crossing the lesion with a workhorse wire, then exchange through a microcatheter or over the wire balloon. This was reflected in reduced fluoroscopy time with OA compared with RA in prior studies [16,17]. The luminal gain with RA is related to the burr size, and if a larger lumen is needed, more devices are required, which can be costly and time-consuming.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

et al. 2021

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Introduction: Our objective was to describe the contemporary outcomes of orbital atherectomy (OA) vs. rotational atherectomy (RA) use for inpatient percutaneous coronary intervention (PCI) in the United States. Data on the use of OA vs. RA in contemporary inpatient PCI are limited. Methods: We queried the Nationwide Readmission Database (NRD) from January to November for the years 2016-2017 to identify hospitalizations of patients who underwent PCI with atherectomy. We conducted a multivariate regression analysis to identify variables associated with in-hospital mortality. Results: We included 77,040 records of patients who underwent inpatient PCI with atherectomy. Of those, 71,610 (93%) had RA, and 5430 (7%) had OA. There was no significant change in the trend of using OA or RA over 2016 and 2017. OA was less utilized in patients presenting with ST-segment elevation myocardial infarction (STEMI) (4.3% vs. 46.8%, p \ 0.001). In our cohort, OA was associated with lower in-hospital mortality (3.1% vs. 5%, p \ 0.001) and 30-day urgent readmission (\ 0.01% vs. 0.2%, p = 0.009), but a higher risk of coronary

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

et al. 2021

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“…Heavy calcification could be eccentric or concentric, located at acute angulations or in long lesions with multiple bends, and encountered in acute coronary syndrome. Though intravascular lithotripsy and orbital atherectomy could share part of work to treat coronary calcification [ 4 ], rotational atherectomy (RA, Boston Scientific, Natick, MA) has long-lasting history in the coronary interventions and is more familiar to most interventionists. Despite high success and low complication rate, incidences of RA-related coronary perforations (CPs) still could not be obviated in the cath labs [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Wang

Chen

et al. 2020

Journal of Interventional Cardiology

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Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall.

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“… 3 – 7 Ischemic event rates were also higher in both the rotational atherectomy and balloon only arms of the ROTAXUS trial (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease), despite the fact that in this trial only ≈50% of the lesions were severely calcified. 1 , 2 However, the extent to which these differences are due to the atherectomy platform versus varying stent types and other patient- and technique-related differences is unknown, particularly in light of comparative data from 2 large registries that found no significant difference in procedural 24 or short-term clinical outcomes 25 after OAS versus rotational atherectomy. Comparative randomized trials are warranted to elucidate differences in procedural safety, effectiveness, and long-term outcomes between these devices.…”

Section: Discussionmentioning

confidence: 99%

Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification

Redfors

Sharma

Saïto

et al. 2020

Circ: Cardiovascular Interventions

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Background: Percutaneous coronary intervention of severely calcified lesions carries a high risk of adverse events despite the use of contemporary devices. The Classic Crown Orbital Atherectomy System (OAS) was safe and effective for severely calcified lesion preparation in the ORBIT II study (Evaluate the Safety and Efficacy of OAS in Treating Severely Calcified Coronary Lesions) but was not optimized for tight lesions. COAST (Coronary Orbital Atherectomy System Study) evaluated the safety and efficacy of calcified lesion preparation before stent implantation with the Diamondback 360 Micro Crown Coronary OAS, designed for use in tighter lesions. Methods: COAST was a prospective, multicenter, single-arm study that enrolled 100 patients with severely calcified de novo coronary lesions at 17 sites in the United States and Japan. The primary effectiveness end point was procedural success, defined as stent delivery with residual stenosis <50% without in-hospital major adverse cardiac events (MACE), and the primary safety end point was freedom from MACE (composite of cardiac death, myocardial infarction, or target vessel revascularization) at 30 days. Results: The OAS Micro Crown was inserted in all patients. A stent was delivered with a residual stenosis <50% in all except one patient (99.0%). Procedural success was achieved in 85 (85.0%) subjects versus 391 (88.9%) in ORBIT II ( P =0.30), and freedom from MACE at 30 days was achieved in 85.0% versus 89.6% in ORBIT II ( P =0.21). Freedom from MACE was 77.8% at 1 year. Conclusions: Prestent preparation of severely calcified lesions using the novel Micro Crown OAS resulted in similar rates of procedural success and freedom from MACE compared with the Classic Crown OAS. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02132611.

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Orbital atherectomy versus rotational atherectomy: A systematic review and meta-analysis

Cited by 23 publications

References 26 publications

Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

Outcomes with Orbital and Rotational Atherectomy for Inpatient Percutaneous Coronary Intervention

Incidence and Mechanisms of Coronary Perforations during Rotational Atherectomy in Modern Practice

Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification

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