Orbital Atherectomy for Treating Severely Calcified High-Risk Coronary Bifurcation Lesions: A Practical Approach - Abstract
Background: Coronary bifurcation lesions account for 15-20% of lesions treated with percutaneous coronary intervention (PCI). Treatment of these lesions may be associated with increased complications. In calcified lesions orbital atherectomy (OA) facilitates stent delivery and improves overall procedural outcomes. However, its feasibility and safety preceding a planned two stent bifurcation strategy has not been established.
Methods: Between January 1, 2016 and September 30, 2019, patients undergoing OA prior to a planned two stent approach for complex calcified bifurcation lesions (medina 1:1:1, 0:1:1, 1:0:1) were retrospectively reviewed. Baseline patient characteristics, procedural variables and clinical outcomes were evaluated post procedure and at 30 days.
Results: Twenty-six (26) consecutive patients undergoing OA prior to stenting (OAptS) were treated with OA of both main and side branches prior to planned two stent bifurcation placement. These patients had advanced cardiovascular disease, multiple comorbidities and were not candidates for coronary artery bypass grafting. Hemodynamic support was used in 7 patients (26.9%). Despite this high-risk patient population, procedures were all successful without significant MACE or target vessel revascularization (TVR) immediately post procedure or at 30 days.
Conclusions: This retrospective study establishes the feasibility and safety of main branch (MB) and side branch (SB) OAptS for complex calcified coronary bifurcation lesions undergoing a pre-planned two stent treatment approach. In this high-risk, carefully selected patient population, OAptS was successfully used without significant MACE or TVR at 30 days.