Outcomes After Coronary Orbital Atherectomy at Centers Without On-Site Surgical Backup: Diabetics Versus Non-Diabetics and Impact of Access Site

Rao, Lakshmi; Rao, Anila; Rao, Surya P.; Rao, Ravi A.; Bhavsar, Janak H.; Liu, Wing Yi; Igyarto, Zsuzsanna; Martinsen, Brad J.

doi:10.1016/j.carrev.2020.09.029

Cited by 7 publications

(9 citation statements)

References 25 publications

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“…While CTO interventions have been associated with higher risk for dissection and emergency surgery, 12,13 retrospective studies report reasonably low complication rates including 4% perforation, 1% tamponade, 1.4% death, 1.1% MI, 1.8% target lesion revascularization, and 1.1% CVA 14,15 . Similarly, retrospective analyses of orbital and rotational atherectomy in no‐SOS centers have acceptable outcomes with 30‐day MACE of 1.4% with orbital atherectomy and overall complication rate of less than 6% with rotational atherectomy 16,17 …”

Section: Discussionmentioning

confidence: 99%

“…14,15 Similarly, retrospective analyses of orbital and rotational atherectomy in no-SOS centers have acceptable outcomes with 30-day MACE of 1.4% with orbital atherectomy and overall complication rate of less than 6% with rotational atherectomy. 16,17 While no-SOS centers perform the minority of PCI cases in the US, many PCIs are done at no-SOS centers internationally and even represent the majority in some countries. 10 Given the above outcomes data and the historical practice variation between the US and international sites, it is unsurprising that our survey found that international operators were much more comfortable in performing PCI on left main lesions, 3-vessel disease, the last remaining conduit, lesions that jeopardize a large amount of myocardial territory, lesions with greater than moderate calcification, and the use atherectomy, cutting balloon, or laser devices.…”

Section: No-sos Operators: Us Versus International Procedural Prefere...mentioning

confidence: 99%

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Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Fernandez,

Shroff,

Vidovich

2023

Cathet Cardio Intervent

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BackgroundPercutaneous coronary intervention (PCI) without surgical backup is becoming increasingly common in the United States. Additionally, a recent SCAI expert consensus document has liberalized recommendations for performing PCI without cardiac surgery on site (SOS).AimsThe current study sought to understand practice patterns and operator preferences with regard to performing PCI without SOS.MethodsTwo internet‐based surveys were distributed to interventional cardiologists worldwide. Survey items asked about operator demographics, procedural preferences when performing PCI without SOS, self‐judged personality traits, and history of malpractice.ResultsBetween March 2021 and May 2021, 517 interventional cardiologists completed the survey; 341 of whom perform elective PCI without SOS (no‐SOS operators), and 176 who perform elective PCI with surgical backup (SOS operators). Most operators were male 473 (91.5%). There was a greater proportion of SOS operators in academic practice (86 vs. 75, p < 0.001) and greater proportion of no‐SOS operators in hospital‐owned practices (158 vs. 56, p < 0.001). Lesion characteristics (left main, chronic total occlusions, and need for atherectomy) were the most important procedural attributes for no‐SOS operators, and international operators reported higher comfort levels with PCI on high‐risk lesions. Cumulative personality profile scores were similar between SOS and no‐SOS operators. SOS operators expressed more concern with legal ramifications of performing PCI without SOS (2.57 vs. 2.34, p = 0.049).ConclusionsIn the absence of surgical backup, lesion characteristics were the most important consideration for PCI patient selection for operators worldwide. Compared to the United States, international operators were more confident in performing high‐risk PCI without surgical backup.

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Section: Discussionmentioning

confidence: 99%

Section: No-sos Operators: Us Versus International Procedural Prefere...mentioning

confidence: 99%

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Fernandez,

Shroff,

Vidovich

2023

Cathet Cardio Intervent

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“…A retrospective analysis of 221 cases using orbital atherectomy at no-SOS sites reported an in-hospital MACE rate of 0.5% (1 MI) and 30-day MACE rate of 1.4%. 39 In-hospital coronary perforation and no reflow were reported at 0.5% and procedural success was 97.3%. A retrospective analysis of 531 patients undergoing rotational atherectomy (RA) in 3 no-SOS centers in Australia noted 11 (2.1%) procedure-related deaths (of which 5 were directly attributable to RA) within 30 days.…”

Section: Pci Of Complex Lesions In No-sos Centersmentioning

confidence: 95%

SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Grines

Box

Mamas

et al. 2023

JACC: Cardiovascular Interventions

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“…Although OA is not approved for in-stent restenosis (ISR), a small study (41 patients) reported technical success of 98%, a MACCE rate of 5% (2 patients) driven solely by procedural MI, severe no reflow in 5% and no perforations requiring interventional therapy, highlighting that OA has a reasonably good safety profile for atherectomy in ISR [24]. OA has also been shown to be safe for use without on-site cardiovascular surgical services, with a low rate of perforation (0.5%), flow-limiting dissection (0.5%), MACE (1.4%) and cardiac death (0.5%) [25], comparable to a multicenter registry report demonstrating an emergency CABG rate of 0.2% [21]. Currently, according to the manufacturer's Instructions for Use (IFU), OA is contraindicated in lesions within a bypass graft or stent, with the presence of thrombus, in the last remaining coronary artery or if there is evidence of coronary dissection [26].…”

Section: Orbital Atherectomymentioning

confidence: 98%

Percutaneous management of calcified coronary arteries – review of atherectomy and lithotripsy devices and why it is important

Burke

Graham²

2021

Current Opinion in Cardiology

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Purpose of reviewCoronary artery calcification (CAC) predisposes to suboptimal revascularization outcomes after percutaneous coronary intervention (PCI). Despite the availability of several plaque modification devices, their rates of use remain low despite the prevalence of CAC encountered in clinical practice. It is important to understand how each device can be utilized in clinical practice in order to improve outcomes after PCI. Recent findingsThis article summarizes the most recent clinical evidence for each plaque modification device. Although rotational atherectomy is the most frequently used device for plaque modification, the use of orbital atherectomy (OA) has been increasing. Balloon-based strategies including recent studies evaluating a novel intravascular lithotripsy balloon have shed light on the benefits of nonablative devices in modifying CAC during PCI. SummaryCAC poses significant technical challenges in achieving optimal stent results. Several intracoronary plaque modification devices are currently available and understanding the technical aspects, indications and contraindications to the use of each device is essential. Although rotational and OA are most commonly used, laser atherectomy and balloon-based devices may offer an advantage in certain lesion subsets.

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Outcomes After Coronary Orbital Atherectomy at Centers Without On-Site Surgical Backup: Diabetics Versus Non-Diabetics and Impact of Access Site

Cited by 7 publications

References 25 publications

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

Interventional cardiologist perceptions about PCI without surgical backup—Results of an international survey

SCAI Expert Consensus Statement on Percutaneous Coronary Intervention Without On-Site Surgical Backup

Percutaneous management of calcified coronary arteries – review of atherectomy and lithotripsy devices and why it is important

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