Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy

An ORBIT II sub-analysis

Evan Shlofmitz, Brad Martinsen, Michael Lee, Philippe Genereux, Ann Behrens, Gautam Kumar, Joseph Puma, Richard Shlofmitz, Jeffrey Chambers

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: We sought to assess the clinical outcomes when intravascular ultrasound (IVUS) was used prior to orbital atherectomy treatment (OA) versus angiography alone for lesion assessment. Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with high rates of major adverse cardiac events (MACE). IVUS provides additional diagnostic information to optimize PCI. Methods: ORBIT II was a single-arm study of 443 patients with de novo, severely calcified coronary lesions treated with OA before stent placement. Patients with IVUS imaging prior to OA (N = 35) were compared to patients without IVUS imaging for initial lesion assessment (N = 405). In this post-hoc sub-analysis procedural outcomes and the 3-year MACE rate were evaluated. Results: The rates of severe angiographic complications were low in patients with and without IVUS imaging prior to OA. There was a significant reduction in the number of stents used in patients with IVUS imaging prior to OA (1.0 ± 0.2 vs 1.3 ± 0.6; P = 0.006) and increased post-OA mean minimal lumen diameter (MLD) (1.6 ± 0.6 mm vs 1.2 ± 0.5 mm; P < 0.001). The 3-year MACE rate was similar in both groups (IVUS: 14.3% vs No IVUS: 24.2%; P = 0.26). Conclusions: There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.

Original languageEnglish (US)
Pages (from-to)570-576
Number of pages7
JournalJournal of Interventional Cardiology
Volume30
Issue number6
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

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Atherectomy
Ultrasonography
Stents
Therapeutics
Percutaneous Coronary Intervention
Angiography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Shlofmitz, Evan ; Martinsen, Brad ; Lee, Michael ; Genereux, Philippe ; Behrens, Ann ; Kumar, Gautam ; Puma, Joseph ; Shlofmitz, Richard ; Chambers, Jeffrey. / Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy : An ORBIT II sub-analysis. In: Journal of Interventional Cardiology. 2017 ; Vol. 30, No. 6. pp. 570-576.
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abstract = "Objectives: We sought to assess the clinical outcomes when intravascular ultrasound (IVUS) was used prior to orbital atherectomy treatment (OA) versus angiography alone for lesion assessment. Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with high rates of major adverse cardiac events (MACE). IVUS provides additional diagnostic information to optimize PCI. Methods: ORBIT II was a single-arm study of 443 patients with de novo, severely calcified coronary lesions treated with OA before stent placement. Patients with IVUS imaging prior to OA (N = 35) were compared to patients without IVUS imaging for initial lesion assessment (N = 405). In this post-hoc sub-analysis procedural outcomes and the 3-year MACE rate were evaluated. Results: The rates of severe angiographic complications were low in patients with and without IVUS imaging prior to OA. There was a significant reduction in the number of stents used in patients with IVUS imaging prior to OA (1.0 ± 0.2 vs 1.3 ± 0.6; P = 0.006) and increased post-OA mean minimal lumen diameter (MLD) (1.6 ± 0.6 mm vs 1.2 ± 0.5 mm; P < 0.001). The 3-year MACE rate was similar in both groups (IVUS: 14.3{\%} vs No IVUS: 24.2{\%}; P = 0.26). Conclusions: There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.",
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Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy : An ORBIT II sub-analysis. / Shlofmitz, Evan; Martinsen, Brad; Lee, Michael; Genereux, Philippe; Behrens, Ann; Kumar, Gautam; Puma, Joseph; Shlofmitz, Richard; Chambers, Jeffrey.

In: Journal of Interventional Cardiology, Vol. 30, No. 6, 01.12.2017, p. 570-576.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy

T2 - An ORBIT II sub-analysis

AU - Shlofmitz, Evan

AU - Martinsen, Brad

AU - Lee, Michael

AU - Genereux, Philippe

AU - Behrens, Ann

AU - Kumar, Gautam

AU - Puma, Joseph

AU - Shlofmitz, Richard

AU - Chambers, Jeffrey

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objectives: We sought to assess the clinical outcomes when intravascular ultrasound (IVUS) was used prior to orbital atherectomy treatment (OA) versus angiography alone for lesion assessment. Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with high rates of major adverse cardiac events (MACE). IVUS provides additional diagnostic information to optimize PCI. Methods: ORBIT II was a single-arm study of 443 patients with de novo, severely calcified coronary lesions treated with OA before stent placement. Patients with IVUS imaging prior to OA (N = 35) were compared to patients without IVUS imaging for initial lesion assessment (N = 405). In this post-hoc sub-analysis procedural outcomes and the 3-year MACE rate were evaluated. Results: The rates of severe angiographic complications were low in patients with and without IVUS imaging prior to OA. There was a significant reduction in the number of stents used in patients with IVUS imaging prior to OA (1.0 ± 0.2 vs 1.3 ± 0.6; P = 0.006) and increased post-OA mean minimal lumen diameter (MLD) (1.6 ± 0.6 mm vs 1.2 ± 0.5 mm; P < 0.001). The 3-year MACE rate was similar in both groups (IVUS: 14.3% vs No IVUS: 24.2%; P = 0.26). Conclusions: There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.

AB - Objectives: We sought to assess the clinical outcomes when intravascular ultrasound (IVUS) was used prior to orbital atherectomy treatment (OA) versus angiography alone for lesion assessment. Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with high rates of major adverse cardiac events (MACE). IVUS provides additional diagnostic information to optimize PCI. Methods: ORBIT II was a single-arm study of 443 patients with de novo, severely calcified coronary lesions treated with OA before stent placement. Patients with IVUS imaging prior to OA (N = 35) were compared to patients without IVUS imaging for initial lesion assessment (N = 405). In this post-hoc sub-analysis procedural outcomes and the 3-year MACE rate were evaluated. Results: The rates of severe angiographic complications were low in patients with and without IVUS imaging prior to OA. There was a significant reduction in the number of stents used in patients with IVUS imaging prior to OA (1.0 ± 0.2 vs 1.3 ± 0.6; P = 0.006) and increased post-OA mean minimal lumen diameter (MLD) (1.6 ± 0.6 mm vs 1.2 ± 0.5 mm; P < 0.001). The 3-year MACE rate was similar in both groups (IVUS: 14.3% vs No IVUS: 24.2%; P = 0.26). Conclusions: There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.

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