Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices

Evan Shlofmitz, Brad J. Martinsen, Michael Lee, Sunil V. Rao, Philippe Généreux, Joe Higgins, Jeffrey W. Chambers, Ajay J. Kirtane, Emmanouil S. Brilakis, David E. Kandzari, Samin K. Sharma, Richard Shlofmitz

Research output: Contribution to journalReview article

21 Scopus citations

Abstract

Introduction: The presence of severe coronary artery calcification is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with non-calcified lesions. Incorporating orbital atherectomy (OAS) for effective preparation of severely calcified lesions can help maximize the benefits of PCI by attaining maximal luminal gain (or stent expansion) and improve long-term outcomes (by reducing need for revascularization). Areas covered: In this manuscript, the prevalence, risk factors, and impact of coronary artery calcification on PCI are reviewed. Based on current data and experience, the authors review orbital atherectomy technique and best practices to optimize lesion preparation. Expert Commentary: The coronary OAS is the only device approved for use in the U.S. as a treatment for de novo, severely calcified coronary lesions to facilitate stent delivery. Advantages of the device include its ease of use and a mechanism of action that treats bi-directionally, allowing for continuous blood flow during treatment, minimizing heat damage, slow flow, and subsequent need for revascularization. The OAS technique tips reviewed in this article will help inform interventional cardiologists treating patients with severely calcified lesions.

Original languageEnglish (US)
Pages (from-to)867-879
Number of pages13
JournalExpert review of medical devices
Volume14
Issue number11
DOIs
StatePublished - Nov 2 2017

Keywords

  • Atherectomy
  • atherectomy technique
  • coronary artery calcification
  • coronary artery disease
  • orbital atherectomy
  • percutaneous coronary intervention
  • stents

ASJC Scopus subject areas

  • Surgery
  • Biomedical Engineering

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    Shlofmitz, E., Martinsen, B. J., Lee, M., Rao, S. V., Généreux, P., Higgins, J., Chambers, J. W., Kirtane, A. J., Brilakis, E. S., Kandzari, D. E., Sharma, S. K., & Shlofmitz, R. (2017). Orbital atherectomy for the treatment of severely calcified coronary lesions: evidence, technique, and best practices. Expert review of medical devices, 14(11), 867-879. https://doi.org/10.1080/17434440.2017.1384695