Abstract
Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 61-67 |
| Number of pages | 7 |
| Journal | Catheterization and Cardiovascular Interventions |
| Volume | 92 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 2018 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
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Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification. / Lee, Michael S.; Gordin, Jonathan S.; Stone, Gregg W.; Sharma, Samin K.; Saito, Shigeru; Mahmud, Ehtisham; Chambers, Jeff; Genereux, Philippe; Shlofmitz, Richard.
In: Catheterization and Cardiovascular Interventions, Vol. 92, No. 1, 01.07.2018, p. 61-67.Research output: Contribution to journal › Article
TY - JOUR
T1 - Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification
AU - Lee, Michael S.
AU - Gordin, Jonathan S.
AU - Stone, Gregg W.
AU - Sharma, Samin K.
AU - Saito, Shigeru
AU - Mahmud, Ehtisham
AU - Chambers, Jeff
AU - Genereux, Philippe
AU - Shlofmitz, Richard
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
AB - Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.
UR - http://www.scopus.com/inward/record.url?scp=85031505772&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85031505772&partnerID=8YFLogxK
U2 - 10.1002/ccd.27339
DO - 10.1002/ccd.27339
M3 - Article
C2 - 29045041
AN - SCOPUS:85031505772
VL - 92
SP - 61
EP - 67
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 1
ER -