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Severe coronary calcification adversely influences success of percutaneous coronary intervention. Lesion modification with Rotational atherectomy (RA) (Boston Scientific) and Orbital atherectomy (OA) (Diamondback 360® (CSI)) help facilitate stent delivery and improve clinical outcomes. We sought to identify differences in safety and efficacy of RA and OA in treatment of calcified coronary lesions.
Between June 2010 and July 2015, all patients at a single center who had attempted treatment with RA or OA were retrospectively evaluated. Demographic, procedural, clinical data and six-month follow-up data were collected by chart review. Two interventional cardiologists independently reviewed each cineangiography to record lesion traits and angiographic outcomes.
Intention to treat analysis was performed for 127 lesions in OA group and 147 in RA group. Baseline demographic and clinical data were comparable between groups. The RA group had significantly higher degrees of calcification and stenosis [Fig 1A]. OA group had more frequent radial access, smaller sheaths and guideliners usage. The primary endpoint of procedural success (successful atherectomy & stent deployment with < 50% residual stenosis) was similar between groups [Fig 1B]. TIMI flow post atherectomy was similar. While composite post-atherectomy procedural complications were higher in OA group, no statistically significant differences were observed in clinical complications, MACE rate, or angina free survival at 6 months follow up [Fig 1B].
Orbital atherectomy and Rotational Atherectomy in contemporary practice are equally safe and effective for plaque modification in significantly calcified coronary artery lesions with high success rates.
CORONARY: Atherectomy (excluding thrombectomy)