In the treatment of highly calcified coronary artery lesions, the Diamondback coronary orbital atherectomy system (OAS) provides a treatment option for calcified plaques with high procedural success rates and low restenosis rates, according to a presentation by Dr. Jumpei Koike of Kyoto Katsura Hospital at the e-Abstract session of ACC 22.
Acute and Mid-Term Results of PCI for Severely Calcified Coronary Artery Lesions with OAS
At Kyoto Katsura Hospital, this study evaluated in-hospital and mid-term outcomes of 539 consecutive cases (416 lesions) who underwent PCI using OAS for severely calcified lesions in coronary arteries from February 2018 to December 2021.
The mean age of the patients was 76 years, 74% were male, 45% had diabetes, and 39% had chronic kidney disease. De novo and in-stent restenotic (ISR) lesions were present in 84% and 7%, respectively, and the LAD was the most common lesion site (52%). At the time of the procedure, IVUS was used in 53% of patients, OFDI/OCT in 44%, and both were used in 3%.
In all cases, OAS was used with low-speed rotation, while high-speed ablation was added in 65% of lesions, and an additional Rotablator was required in 64 lesions (12%). Finally, 84% of lesions were treated with drug-coated balloons (DCB), 14% with stents, and 2% with POBA. The success rate of the procedure was 96%. Complications included persistent slow flow/no reflow in 3% and coronary perforation in 1%.
In-hospital MACE was seen in 10%, with a 10% perioperative MI (0.5% Q-wave MI, 9.5% non-Q-wave MI), one cardiac death (0.02%), and zero TVF (TLR/TVR). In 327 patients, after 8 months (with a mean follow-up of 608 days), the rate of MACE after discharge was 17%; Cardiac death occurred in 3%, MI in 0%, TLR in 8%, and TVF (TLR + TVR) in 14%. A follow-up angiography after 8 months (with a mean follow-up of 255 days) was performed in 292 lesions (70%) with a restenosis rate of 9% (DCB 11%, stent 2%, and POBA 0%).
Dr. Koike summarized, “OAS has been shown to have a high procedural success rate and a low restenosis rate, and is going to be another option for reducing calcified plaque.”
※コンテンツには、国内で未承認、適応外の医療機器、医薬品、または効能・効果/用法・用量の情報を含む場合がありますが、未承認、適応外の使用を推奨するものではありません。
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