A retrospective cohort study comparing safety and effectiveness of rotational atherectomy (RA) or orbital atherectomy (OA) in treating severe coronary artery calcification in patients undergoing percutaneous coronary intervention (PCI) found similar rates of procedural success. The findings were presented Sept. 25 at TCT 2019 and simultaneously published in JACC: Cardiovascular Interventions.

Devika Aggarwal, MBBS, et al., analyzed data from 135,243 consecutive PCIs performed between January 2014 and March 2018 at 48 hospitals participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. An atherectomy device was used in 2,994 (2.21 percent) cases, with OA used in 1,033 and RA used in 1,801. Optimal full propensity matching and stratified logistic regression was used to evaluate the impact of atherectomy device choice on outcomes adjusting for patient characteristics. Procedural success was defined as residual stenosis ≤ 30 percent and perfect procedural success was defined as residual stenosis ≤ 10 percent.

Overall findings found both OA and RA were associated with similar rates of both procedural success (94.2 percent vs. 94.6 percent, respectively) and perfect procedural success (88.6 percent vs. 89.8 percent, respectively). Researchers observed no differences between the two groups in the incidence of perforation, NCDR defined bleeding, major bleeding, stent thrombosis, persistent no reflow, emergency or salvage CABG, and all cause death. Additionally, data showed a significant increase in both RA and OA use over the study period, with RA or OA used at least once by 249 operators (68.2 percent). However, researchers noted that OA use increased more rapidly. Operators who used OA also were found to use RA, while a substantial number of operators only used RA.

According to the researchers, "the overall similar outcomes suggest that the operators' use of their preferred device was associated with similar outcomes irrespective of the specific atherectomy treatment modality. With similar safety and effectiveness profiles, either OA or RA can be used in the treatment of increasingly prevalent severe coronary artery calcification."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Angiography

< Back to Listings