Plaque modification of severely calcified coronary lesions via orbital atherectomy: Single-center observations from a complex Veterans Affairs cohort.

• Type of Material: Article
• Authors: Rupak Desai, Emory University; Omer Mirza, Emory University; Brad J. Martinsen, Cardiovascular Systems, Inc.; Gautam Kumar, Emory University
• Language: English
• Date: 2018-12
• Publisher: Wiley Open Access
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors. Health Science Reports published by Wiley Periodicals, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1002/hsr2.99
• Title of Journal or Parent Work: Health Science Reports
• ISSN: 2398-8835
• Volume: 1
• Issue: 12
• Start Page: e99
• End Page: e99
• Grant/Funding Information: This research is the result of work supported with resources and the use of facilities at the Atlanta VA Medical Center.; This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.
• Keywords: percutaneous coronary intervention, complex PCI; chocolate focal force angioplasty; coronary artery disease; orbital atherectomy; coronary artery calcification
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Orbital atherectomy (OA) is a known alternative to other atherectomy devices. However, some complex patient demographics (eg, left ventricular ejection fraction <25%) were excluded from the first-in-human trial (ORBIT I) and the pivotal FDA device approval trial (ORBIT II) which evaluated the safety and efficacy of OA in severely calcified de novo coronary lesions. This single-operator cohort study aimed to examine the impact of OA on a real-world complex Veterans Affairs patient subset. Methods: Retrospective analysis was completed on 40 consecutive patients with severely calcified coronary lesions who underwent OA prior to drug-eluting stent placement at the Atlanta Veterans Affairs Medical Center from January 2015 to June 2017. Results: Orbital atherectomy plus drug-eluting stent placement was successful in all 40 cases. Chocolate focal force balloon angioplasty was the most commonly used post-atherectomy balloon (N = 34, 85%). Few complications were observed, including one case (2.5%) of perforation and one case (2.5%) of no-reflow. Neither acute stent thrombosis nor emergent coronary artery bypass grafting was observed. The intravascular ultrasound (IVUS)-determined median [IQR] pre-procedure minimum lumen area and post-procedure minimum stent area (MSA) were 2.8 [2.2, 3.0] mm2 and 8.7 [7.7, 10.0] mm2, respectively (P < 0.0001, Mann-Whitney test). Major adverse cardiovascular events, including all-cause mortality, at 30 days and at a median [IQR] follow-up of 197.5 [35.5, 461.3] days, was 5% and 10%, respectively. During that period, one target vessel revascularization (2.5%) was observed. Conclusions: This study indicates that OA is a useful tool in performing high-risk percutaneous coronary intervention effectively in VA patients with severely calcified coronary lesions. OA plaque modification in combination with a high utilization rate of IVUS and Chocolate focal force angioplasty facilitates stent delivery and optimal stent expansion, resulting in a large MSA.