Evolving Atherectomy Use for Treating Calcified Coronary Lesions: A Single Center 10-year Real World Experience
Presenter
Francis Zirille, Indiana University School of Medicine, Indianapolis, IN
Francis Zirille1, Matthew Hodge, MD1, Benjamin Maatman, MD2 and George E. Revtyak, M.D., FSCAI3, (1)Indiana University School of Medicine, Indianapolis, IN, (2)Community Heart And Vascular, Fishers, IN, (3)SAVAHCS, Tucson, AZ
Keywords: Atherectomy, Coronary and Vascular Access, Management, and Closure
Background:
Percutaneous coronary intervention (PCI) for severely calcified coronary lesions is associated with lower procedural success and higher complications. Atherectomy prior to stenting has become an important adjunct for treating these calcified stenoses. As atherectomy technology and technique has evolved, overall procedural success has improved, but clinical outcome data directly comparing available atherectomy devices is limited.
Methods:
Between January 1, 2010 and December 31, 2019, clinical data and coronary angiograms for patients undergoing atherectomy prior to stenting for calcified coronary lesions at IU Health Methodist Hospital were retrospectively reviewed. Data were pooled, and patients divided into rotational (RA) and orbital (OA) atherectomy groups. Demographic and procedural variables with 30 day and 1-year death, MACE and bleeding events were compared between these groups.
Results:
For this study, data from 368 patients was analyzed (158 RA and 210 OA). Yearly RA use remained constant between 1-2% of our total PCI volume during the study period. OA use, however, steadily increased after its introduction in November 2015 to a maximum of 12% in 2019. Demographic and procedural variables were similar between RA and OA groups (p=NS). Death, MACE and bleeding at 30 days and 1-year were also similar for both groups (p=NS). Transradial (TR) access was more frequent in OA patients (50%) than RA patients (15%) compared to transfemoral (TF). When 30 day and 1-year atherectomy outcomes were reanalyzed by access site, death and MACE were similar for TR and TF patients (p=NS), but bleeding events were significantly reduced for TR patients (p=0.02).
Conclusions:
In our institution, both RA and OA have been successfully used to treat calcified coronary lesions with similar short- and long-term outcomes. The rapid increase of OA use in our hands likely reflects improvement in atherectomy technology, ease of device use and/or increased operator comfort. Also, TR access for atherectomy may improve overall procedural safety by reducing bleeding events. Finally, our data suggests that atherectomy technology and technique have improved significantly over the past decade.