Impact of Orbital Atherectomy on Side Branch Patency in Severely Calcified Coronary Artery Lesions: A Retrospective Single-Center Experience.
Academic Article
Overview
abstract
BACKGROUND: Severe coronary artery calcification is associated with reduced procedural success and increased long-term adverse events. Orbital atherectomy (OA) is a commonly used plaque-modification strategy in this setting. However, the impact on side branch (SB) patency remains undefined. AIM: To evaluate side branch patency and associated clinical outcomes in patients with severely calcified coronary lesions undergoing OA. METHODS: We conducted a single-center, retrospective analysis of 272 patients who underwent orbital atherectomy between January 1, 2021, and December 1, 2024. We identified and included lesions with a SB ≥2.0 mm in diameter within the main branch (MB) stented area. A total of 142 SB vessels were identified. Pre and postprocedural SB TIMI flow grade was assessed, procedural complications and major adverse cardiovascular events (MACE) were recorded at discharge, 30 days and 1 year. RESULTS: Mean age was 70.7 with 70.7% of patients being male. 50.7% of patients had diabetes, 41.5% had chronic kidney disease, 33.8% had heart failure, 12.0% had prior coronary artery bypass grafting and 17.6% had been referred for surgery and deemed ineligibile. Adjunctive device use was low. The mean number of burr passes was 11.5±5.9. The most common SB vessels were diagonal (60.5%), SB ballooning was performed in 16.2% and stenting in 10.6% of cases. SBs had preprocedure TIMI 3 flow in 93.7% of cases and final TIMI 3 flow in 93.7%. Procedural complications and MACE events at discharge, 30-days and 1-year were low. CONCLUSION: In this single-center, retrospective analysis, the use of orbital atherectomy in heavily calcified MB vessels with an adjacent SB ≥ 2.0 mm in diameter resulted in high rates of SB TIMI 3 flow with low rates of complications. These findings highlight the need for further prospective, multicenter studies to define the impact of OA on SB preservation.
