Predictors of side branch compromise in calcified bifurcation lesions treated with orbital atherectomy

Abstract

Objectives The aim of the study was to identify the predictors of side branch (SB) compromise in severely calcified bifurcation lesions treated with orbital atherectomy (OA). Background SB compromise remains a major complication of bifurcation lesion percutaneous coronary intervention (PCI). Higher prevalence of lipid‐rich plaques and spotty calcification by optical coherence tomography (OCT) and SB ostial stenosis by angiography have been previously suggested as predictors of SB occlusion after main vessel (MV) stenting. Methods Patients with chronic stable angina and severely calcified bifurcation lesions, in whom provisional stenting strategy was planned, were enrolled in the study. OA was used for lesion preparation in all cases. OCT imaging of the MV was performed before and after stenting. SB compromise was defined as a composite of SB occlusion (TIMI flow grade ≤ 2) and SB intervention after MV stenting. Results Thirty stable CAD patients with 30 severely calcified bifurcation lesions were included in the study. Twelve patients (40%) had a compromised SB after MV stenting. Compromised SB was characterized by a greater angiographic diameter stenosis (55.4 ± 8.1% vs. 35.0 ± 14.4%, P < 0.01) and a smaller minimal lumen diameters (0.79 ± 0.17 vs. 1.12 ± 0.30 mm, P = 0.002) before PCI compared to noncompromised SB. The prevalence of OCT lipid‐rich plaques was low and did not differ between the groups (18 vs. 19%, P = 0.68). There was no difference in other OCT plaque characteristics including the presence of spotty calcification. Conclusion The severity of SB ostial disease and not MV plaque morphology contributed to SB compromise in severely calcified bifurcation lesions.

Management of calcified coronary artery bifurcation lesions

“…Barman et al studied predictors of SB compromise in severely calcified bifurcation lesions treated with orbital atherectomy (OA). In this study, severity of SB ostial disease was associated with SB compromise 27 . Calcification of SB was found to be an independent predictor of SB jailing in a COBIS sub study 28 …”

Side branch fractional flow reserve after provisional stenting of calcified bifurcation lesions: The ORBID‐FFR study

“…Adequate lesion preparation prior to stent implantation in heavily calcified lesions may improve clinical outcomes 11‐13 . Cutting or scoring balloons, atherectomy (rotational or orbital), lasers and intravascular lithotripsy may be used for this purpose 14,22,25‐27 . The comparative impact of these approaches on ablation efficiency, compliance improvement and SB compromise has not been established.…”

“…[11][12][13] Cutting or scoring balloons, atherectomy (rotational or orbital), lasers and intravascular lithotripsy may be used for this purpose. 14,22,[25][26][27] The comparative impact of these approaches on ablation efficiency, compliance improvement and SB compromise has not been established. Intravascular imaging provides insights to the mechanisms associated with SB compromise following bifurcation PCI.…”

“…Three‐dimensional quantitative coronary angiography (3D‐QCA) analysis of bifurcation lesions was performed by experienced analysts (Naotaka Okamoto, Yuliya Vengrenyuk) using bifurcation edition of validated software package QAngio XA 3D (Medis, Leiden, The Netherlands) as previously described 22‐24 (Figure 2a). Two angiographic views with a projection angles at least 25 0 apart were acquired for each lesion and used for 3D reconstruction.…”

Procedural and 1‐year clinical outcomes of orbital atherectomy for treatment of coronary in‐stent restenosis: A single‐center, retrospective study

“…The ORBIT II trial described the safety and efficacy of OA in de novo calcified coronary lesions 7 . We have described the use of OA for the treatment of calcified bifurcation lesions 8 . Recently feasibility and safety of OA for treatment of ISR secondary to stent underexpansion is reported, however the use of OA for ISR is still off‐label and long‐time clinical outcomes have not been described 9 .…”