Real‐World Multicenter Registry of Patients with Severe Coronary Artery Calcification Undergoing Orbital Atherectomy

Abstract

ObjectivesWe evaluated the safety and efficacy of orbital atherectomy in real‐world patients with severe coronary artery calcification (CAC).BackgroundThe presence of severe CAC increases the complexity of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. Atherectomy may be an indispensable tool for uncrossable or undilatable lesions by modifying severe CAC. Although the ORBIT I and II trials report that orbital atherectomy was safe and effective for the treatment of severe CAC, patients with kidney disease, recent myocardial infarction, long diffuse disease, severe left ventricular dysfunction, and unprotected left main disease were excluded.MethodsThis retrospective study included 458 consecutive patients with severe CAC who underwent orbital atherectomy followed by stenting from October 2013 to December 2015 at 3 centers.ResultsThe primary endpoint of major adverse cardiac and cerebrovascular events at 30 days was 1.7%. Low rates of 30‐day all‐cause mortality (1.3%), myocardial infarction (1.1%), target vessel revascularization (0%), stroke (0.2%), and stent thrombosis (0.9%) were observed. Angiographic complications were low: perforation was 0.7%, dissection 0.9%, and no‐reflow 0.7%. Emergency coronary artery bypass graft surgery was performed in 0.2% of patients.ConclusionIn the largest real‐world study of patients who underwent orbital atherectomy, including high‐risk patients who were not surgical candidates as well as those with very complex coronary anatomy, acute and short‐term adverse clinical event rates were low. A randomized clinical trial is needed to identify the ideal treatment strategy for patients with severe CAC.

Outcomes in Elderly Patients With Severely Calcified Coronary Lesions Undergoing Orbital Atherectomy

“…Our multicenter registry reported low rates of angiographic and adverse clinical events in 458 patients with severe CAC who underwent orbital atherectomy followed by stenting . Outcomes of elderly patients who underwent orbital atherectomy have not been previously described.…”

Pseudoaneurysm of the left main coronary artery: A complication of orbital atherectomy

“…While all four patients who experienced dissections were treated successfully with stent deployment, two of the three patients who experienced perforation died. Overall, emergency coronary artery bypass grafting (CABG) was required in only 0.2% of patients in this study . When compared to rotational atherectomy, the frequency of coronary artery dissection and perforation after orbital atherectomy is similar, and are rare events for both procedures .…”

“…The ORBIT II Trial reported severe coronary artery dissections in 3.4% of participants (2.3% immediately post‐atherectomy) and coronary artery perforations in 1.8% of participants (0.9% immediately post‐atherectomy) . A retrospective study evaluating the outcomes of orbital atherectomy in 458 patients at three institutions in the United States in a “real world” clinical setting showed a lower incidence of coronary artery perforation (0.7%) and coronary artery dissection (0.9%) . While all four patients who experienced dissections were treated successfully with stent deployment, two of the three patients who experienced perforation died.…”

Broken arrow: Successful retrieval of a dislodged coronary orbital atherectomy microtip

“…In this case, we experienced an unusual and potentially catastrophic complication of atherectomy microtip dislodgement and entrapment in the coronary artery ‐ a “broken arrow” that required meticulous, safe retrieval in order to ensure a favorable clinical outcome. Previously described complications of orbital coronary atherectomy included dissection, perforation, slow flow/no reflow, and abrupt vessel closure . In the ORBIT II trial, these complications were rare with reported incidences of 3.4, 1.8, and 1.8%, respectively , and in the real world experience, complication rates were even lower .…”