Orbital Atherectomy Improves Stent Apposition and Expansion

A study published in The Journal of Catheterization and Cardiovascular Intervention has found there is significant modification associated with orbital atherectomy (OA), leading to better stent apposition and expansion, compared with rotational atherectomy (RA) in treating heavily calcified coronary lesions.

The article, titled “Optical Coherence Tomography Assessment of the Mechanistic Effects of Rotational and Orbital Atherectomy in Severely Calcified Coronary Lesions,” details results from a study led by Annapoorna Kini, M.D., professor of Cardiology at the Mount Sinai Hospital and Icahn School of Medicine in New York, N.Y., and director of The Cardiac Catheterization Lab at Mount Sinai Hospital.

“We found that using OA versus RA to treat heavily calcified coronary lesions resulted in more significant tissue modification leading to better stent apposition and expansion. This may translate to lower major adverse cardiac event, or MACE, and restenosis rates,” said study co-investigator, Samin K. Sharma, M.D., director of Clinical and Interventional Cardiology at the Mount Sinai Medical Center.

Kini’s study sought to assess the mechanical effects of RA and OA on heavily calcified coronary lesions and subsequent stent placement using optical coherence tomography, an established medical imaging technique that uses light to capture three-dimensional images from within arteries and other biological tissue. The retrospective analysis included 20 consecutive patients who were treated with either RA or OA. While small case reports have described the mechanistic effect of RA in calcified coronary lesions, there has been no imaging study to assess the effect of OA on coronary artery architecture and/or compare the effects of two atherectomy devices.

Coronary artery disease (CAD) is a life-threatening condition and a leading cause of death in men and women in the United States. CAD occurs when a fatty material called plaque builds up on the walls of arteries that supply blood to the heart. The plaque buildup causes the arteries to harden and narrow (atherosclerosis), reducing blood flow. The risk of CAD increases if a person has one or more of the following: high blood pressure, abnormal cholesterol levels, diabetes, or family history of early heart disease.

According to the American Heart Association, 16.3 million people in the United States have been diagnosed with CAD, the most common form of heart disease. Heart disease claims more than 600,000 lives in the United States each year. According to estimates, significant arterial calcium is present in nearly 40 percent of patients undergoing a percutaneous coronary intervention (PCI). Significant calcium contributes to poor outcomes and higher treatment costs in coronary interventions when traditional therapies are used, including a significantly higher occurrence of death and major adverse cardiac events (MACE).