The efficacy of orbital atherectomy is associated with prior rotational atherectomy and a greater preprocedural lumen area.

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.