Impact of the Use of Intravascular Imaging on Patients Who Underwent Orbital Atherectomy

• Published in: The Journal of invasive cardiology Vol. 30; no. 2; p. 77
• Main Authors: Lee, Michael S, Shlofmitz, Evan, Kong, Jeremy, Lluri, Gentian, Srivastava, Pratyaksh K, Shlofmitz, Richard
• Format: Journal Article
• Language: English
• Published: United States 01-02-2018
• Subjects: Aged; Atherectomy, Coronary - adverse effects; Atherectomy, Coronary - methods; Coronary Angiography - methods; Coronary Artery Disease - diagnosis; Coronary Artery Disease - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Coronary Vessels - surgery; Female; Humans; Male; Middle Aged; Outcome and Process Assessment (Health Care); Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Reoperation - methods; Reoperation - statistics & numerical data; Stents - adverse effects; Stroke - diagnosis; Stroke - etiology; Stroke - prevention & control; Surgery, Computer-Assisted - adverse effects; Surgery, Computer-Assisted - methods; Ultrasonography, Interventional - methods; United States - epidemiology; Vascular Calcification - diagnosis; Vascular Calcification - surgery
• EISSN: 1557-2501

We assessed the impact of intravascular ultrasound (IVUS)/optical coherence tomography (OCT) on outcomes of patients who underwent orbital atherectomy.
Intravascular imaging provides enhanced lesion morphology assessment and optimization of percutaneous coronary intervention (PCI) outcomes. Severe coronary artery calcification increases the complexity of PCI and is associated with worse clinical outcomes. Orbital atherectomy modifies calcified plaque, facilitating stent delivery and optimizing stent expansion. The impact of IVUS/OCT on clinical outcomes after orbital atherectomy is unknown.
Of the 458 consecutive real-world patients in our retrospective multicenter registry, a total of 138 patients (30.1%) underwent orbital atherectomy with IVUS/OCT. The primary safety endpoint was the rate of 30-day major adverse cardiac and cerebrovascular events, comprised of death, myocardial infarction (MI), target-vessel revascularization (TVR), and stroke.
The IVUS/OCT group and no-imaging group had similar rates of the primary endpoint (1.5% vs 2.5%; P=.48) as well as death (1.5% vs 1.3%; P=.86), MI (1.5% vs 0.9%; P=.63), TVR (0% vs 0%; P=NS), and stroke (0% vs 0.3%; P=.51). The 30-day stent thrombosis rates were low in both groups (0.7% vs 0.9%; P=.82). Emergent coronary artery bypass graft surgery was uncommonly performed in both groups (0.0% vs 0.9%; P=.25).
Orbital atherectomy guided by intravascular imaging is feasible and safe. A large prospective randomized trial is needed to determine the clinical benefit of IVUS/OCT during PCI with orbital atherectomy.