Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy: An ORBIT II sub‐analysis

Abstract

There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.

Modern‐Day Nationwide Utilization of Intravascular Ultrasound and Its Impact on the Outcomes of Percutaneous Coronary Intervention With Coronary Atherectomy in the United States

“…Correspondingly, Singh et al 12 reported higher cardiovascular complications in IVUS‐guided PCI procedures on comparison to angiography‐assisted PCI procedures. However, 3 years’ follow‐up MACE in IVUS‐assisted orbital atherectomy have been found to be comparable to non–IVUS‐guided procedures . Our findings of lower short‐term (in‐hospital or within 30 days) all‐cause mortality in IVUS‐guided PCIs have been also described by the CathPCI Registry and the MATRIX registry alongside with greater risk of bleeding and cardiac complications .…”

“…The procedural and clinical outcomes in terms of restenosis and redo revascularization rates have shown improvement with IVUS‐guided PCI procedures . It is also reported that IVUS‐guided orbital atherectomy increased minimal lumen diameter, and fewer stents were required to be positioned following the procedure, which further designates the role of IVUS in the better measurement of calcified lesions. Compared to the angiography‐guided coronary interventions, IVUS‐assisted procedures showed up to a 20% reduction in MACE .…”

Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

“…The low rate of TLR/TVR in the ORBIT II trial continued out to 3 years (Table 4) [51]. Numerous ORBIT II sub-analyses have been published [53][54][55][56]66,67]. For example, a gender sub-analysis indicated no difference in primary safety and efficacy endpoints; however, females had an increased risk for severe dissection [53].…”

“…If the lesion is too stenotic to perform an initial intravascular imaging assessment, it is still useful to complete intravascular imaging post-OAS prior to stent deployment to confirm adequate vessel preparation, assess accurate sizing of the vessel, and to ensure the areas treated with OAS will be covered by the stent length chosen. Recently, a sub-analysis of the ORBIT II trial data found that there were significantly fewer stents placed and increased post-OAS minimum lumen diameter in patients with IVUS assessment of the degree of lesion calcification prior to OAS as compared to patients with angiographic assessment of the degree of lesion calcification [66]. Thus, intravascular imaging post-OAS can ensure the calcium has been adequately treated and allow for more sensitive detection of dissections that may require treatment.…”

Comment on “Modern‐Day Nationwide Utilization of Intravascular Ultrasound and Its Impact on the Outcomes of Percutaneous Coronary Intervention With Coronary Atherectomy in the United States”

“…Intravascular imaging–based studies have demonstrated the varied mechanisms and impacts of the two devices . Building on the study by Desai and colleagues with data from more recent years once available would provide important insight given the known safety of IVUS with orbital atherectomy demonstrated in both a clinical trial and real‐world setting . Further insights into the role of intravascular imaging and the treatment of calcified coronary disease will likely come from the ongoing ECLIPSE (NCT03108456), Disrupt CAD III (NCT03595176), and ILLUMIEN IV: Optimal PCI (NCT03507777) clinical trials.…”