Coronary artery disease · 2025
The efficacy of orbital atherectomy is associated with prior rotational atherectomy and a greater preprocedural lumen area.
СтатьяНазвание и аннотация: Перевод в очереди
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Amisaki Ryosuke, Watanabe Tomomi, Kato Masaru
Аннотация
BACKGROUND: Percutaneous coronary intervention (PCI) in severely calcified lesions remains challenging. While orbital atherectomy is a treatment option for calcified lesions, the specific patient and lesion characteristics that predict successful debulking with orbital atherectomy remain unclear. This study aimed to identify the factors associated with a greater minimum lumen area (MLA) after orbital atherectomy.
METHODS: We retrospectively identified 77 lesions in 68 patients who underwent PCI with orbital atherectomy at Tottori University Hospital from May 2020 to June 2024. Among these, 62 lesions with a measurable intraluminal area by intravascular imaging were included in the analysis. The lesions were divided into two groups on the basis of a median post-orbital atherectomy MLA of 2.5 mm 2 : the large group (≥2.5 mm 2 ) and the small group (<2.5 mm 2 ). We compared the patients' background, characteristics of the lesions, procedural details, and imaging findings between the two groups.
RESULTS: The large group more frequently had prior rotational atherectomy use (35.5 vs. 3.2%; P = 0.004) and had a greater pre-orbital atherectomy MLA [2.36 (2.01-3.10) vs. 1.37 mm 2 (0.99-1.76); P < 0.001] than the small group. No significant differences in major complications or 1-year outcomes were observed between the two groups.
CONCLUSION: Optimal lumen gain following orbital atherectomy was associated with a greater pre-orbital atherectomy MLA and prior rotational atherectomy. Pretreatment with rotational atherectomy may establish a sufficient lumen, subsequently enhancing the efficacy of orbital atherectomy. These results suggest the effectiveness of a strategy of using rotational atherectomy before orbital atherectomy.
METHODS: We retrospectively identified 77 lesions in 68 patients who underwent PCI with orbital atherectomy at Tottori University Hospital from May 2020 to June 2024. Among these, 62 lesions with a measurable intraluminal area by intravascular imaging were included in the analysis. The lesions were divided into two groups on the basis of a median post-orbital atherectomy MLA of 2.5 mm 2 : the large group (≥2.5 mm 2 ) and the small group (<2.5 mm 2 ). We compared the patients' background, characteristics of the lesions, procedural details, and imaging findings between the two groups.
RESULTS: The large group more frequently had prior rotational atherectomy use (35.5 vs. 3.2%; P = 0.004) and had a greater pre-orbital atherectomy MLA [2.36 (2.01-3.10) vs. 1.37 mm 2 (0.99-1.76); P < 0.001] than the small group. No significant differences in major complications or 1-year outcomes were observed between the two groups.
CONCLUSION: Optimal lumen gain following orbital atherectomy was associated with a greater pre-orbital atherectomy MLA and prior rotational atherectomy. Pretreatment with rotational atherectomy may establish a sufficient lumen, subsequently enhancing the efficacy of orbital atherectomy. These results suggest the effectiveness of a strategy of using rotational atherectomy before orbital atherectomy.