Outcomes of orbital atherectomy in severely calcified small (2.5 mm) coronary artery vessels
J Invasive Cardiol
© 2018 HMP Communications.All Rights Reserved. OBJECTIVES: We evaluated the outcomes of plaque modification with orbital atherectomy followed by percutaneous coronary intervention (PCI) with small-diameter stents for severely calcified coronary arteries. BACKGROUND: PCI of severely calcified lesions is technically complex due to difficulties in predilating the lesion, delivering the stent, and achieving optimal stent expansion. PCI of small-diameter vessels is associated with an increased risk of adverse clinical events. METHODS: In our retrospective multicenter registry of 458 "all comers" with severe coronary artery calcification treated with orbital atherectomy, a total of 38 patients (8.3%) underwent stenting with a 2.5 mm diameter stent (small-vessel group) and 420 patients (91.7%) had a reference vessel diameter >2.5 mm (large-vessel group). The primary endpoint was the 30-day rate of major adverse cardiac and cerebrovascular events, which was the composite of death, myocardial infarction (MI), target-vessel revascularization (TVR), and stroke. RESULTS: The small-vessel and large-vessel groups had similar rates of perforation (0.0% vs 0.7%; P≤.80), dissection (2.6% vs 0.7%; P≤.20), and no-reflow (0.0% vs 0.7%; P≤.80). The primary endpoint was similar in both groups (0.0% vs 1.9%; P≤.40), as were the rates of death (0.0% vs 1.4%; P≤.40), MI (0.0% vs 1.2%; P≤.50), TVR (0.0% vs 0.0%; P>.99), and stroke (0.0% vs 0.2%; P≤.90). The small-vessel and large-vessel groups had similar rates of stent thrombosis (0.0% vs 1.0%; P≤.70). CONCLUSIONS: Orbital atherectomy followed by stenting of small-diameter vessels appears to be feasible and safe. Further studies are needed to determine the ideal revascularization strategy for these patients. perforation stent thrombosis.
310 - 314
School of Medicine