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OPTICAL COHERENCE TOMOGRAPHY ASSESSMENT OF CORONARY ATHERECTOMY EFFECT: COMPARISON BETWEEN ORBITAL AND ROTATIONAL ATHERECTOMY IN SEVERELY CALCIFIED LESIONS
1062 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology OPTICAL COHERENCE TOMOGRAPHY ASSESSMENT OF CORONARY ATHERECTOMY EFFECT: COMPARISON BETWEEN ORBITAL AND ROTATIONAL ATHERECTOMY IN SEVERELY CALCIFIED LESIONS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology Presentation Number: 1115-183 Authors: Myong Hwa Yamamoto, Akiko Maehara, Gary Mintz, Keyvan Karimigalougah, Sung Sik Kim, Kisaki Amemiya, Monica Losquadro, Elizabeth Haag, Jeffrey Moses, Fernando Sosa, Richard Shlofmitz, Masahiko Ochiai, Ziad Ali, Cardiovascular Research Foundation, New York, NY, USA Background: The comparative impact of Orbital Atherectomy (OA) vs Rotational Atherectomy (RA) on calcified (Ca) plaque prior to stent implantation is not well known. Methods: Lesions with a maximum Ca angle ≥270° treated with OA (n=22) were compared to RA (n=20). Optical coherence tomography was performed post-atherectomy and post-stent and analyzed every 3mm.
Results: After either OA or RA, Ca modification (round, concave polished lumen surface) or tissue modification (damage of soft plaque or normal vessel wall) was always located at the site of the guidewire. Ca modification tended to be more frequent after OA vs RA (p=0.09), especially at the site of a lumen area >4mm2 (Table) while the prevalence of Ca modification was similar at the site of a small lumen area (≤4mm2). Tissue modification also trended more frequent in the OA group. However, the final minimum stent area was similar between OA vs RA-treated lesions even though OA was used in larger vessels than RA.
Conclusions: Compared to RA, OA caused more Ca ablation in lesions with a larger lumen, but at the expense of more soft tissue or normal vessel wall damage suggesting less effective differential cutting. Nevertheless, final stent areas were similar after pre-treatment with either device. Table Frames with any Ca, n Maximum Ca angle (degree) Average lumen area (mm2) Ca modification Ca modification with lumen area (≤4mm2) Ca modification with lumen area (>4mm2) Tissue modification Final minimum stent area (mm2) Reference lumen area
OAS (n=22) 250 322 [304, 360] 4.4 [3.2, 6.0] 69.6% (174/250) 72.1% (75/104) 67.8% (99/146) 10.6% (24/250) 5.2 [3.9, 6.5] 7.5 [5.9, 8.7]
RA (n=20) 197 322 [283, 360] 3.0 [2.2, 4.0] 61.9% (122/197) 68.0% (102/150) 42.6% (20/47) 5.1% (10/197) 4.8 [4.0, 5.3] 5.1 [4.7, 8.4]
P-value 0.61 <0.001 0.09 0.48 0.002 0.07 0.53 0.03
Interventional Cardiology OPTICAL COHERENCE TOMOGRAPHY ASSESSMENT OF CORONARY ATHERECTOMY EFFECT: COMPARISON BETWEEN ORBITAL AND ROTATIONAL ATHERECTOMY IN SEVERELY CALCIFIED LESIONS Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: Interventional Cardiology: Intravascular Physiology and Endothelial Function Abstract Category: 23. Interventional Cardiology: IVUS and Intravascular Physiology Presentation Number: 1115-183 Authors: Myong Hwa Yamamoto, Akiko Maehara, Gary Mintz, Keyvan Karimigalougah, Sung Sik Kim, Kisaki Amemiya, Monica Losquadro, Elizabeth Haag, Jeffrey Moses, Fernando Sosa, Richard Shlofmitz, Masahiko Ochiai, Ziad Ali, Cardiovascular Research Foundation, New York, NY, USA Background: The comparative impact of Orbital Atherectomy (OA) vs Rotational Atherectomy (RA) on calcified (Ca) plaque prior to stent implantation is not well known. Methods: Lesions with a maximum Ca angle ≥270° treated with OA (n=22) were compared to RA (n=20). Optical coherence tomography was performed post-atherectomy and post-stent and analyzed every 3mm.
Results: After either OA or RA, Ca modification (round, concave polished lumen surface) or tissue modification (damage of soft plaque or normal vessel wall) was always located at the site of the guidewire. Ca modification tended to be more frequent after OA vs RA (p=0.09), especially at the site of a lumen area >4mm2 (Table) while the prevalence of Ca modification was similar at the site of a small lumen area (≤4mm2). Tissue modification also trended more frequent in the OA group. However, the final minimum stent area was similar between OA vs RA-treated lesions even though OA was used in larger vessels than RA.
Conclusions: Compared to RA, OA caused more Ca ablation in lesions with a larger lumen, but at the expense of more soft tissue or normal vessel wall damage suggesting less effective differential cutting. Nevertheless, final stent areas were similar after pre-treatment with either device. Table Frames with any Ca, n Maximum Ca angle (degree) Average lumen area (mm2) Ca modification Ca modification with lumen area (≤4mm2) Ca modification with lumen area (>4mm2) Tissue modification Final minimum stent area (mm2) Reference lumen area
OAS (n=22) 250 322 [304, 360] 4.4 [3.2, 6.0] 69.6% (174/250) 72.1% (75/104) 67.8% (99/146) 10.6% (24/250) 5.2 [3.9, 6.5] 7.5 [5.9, 8.7]
RA (n=20) 197 322 [283, 360] 3.0 [2.2, 4.0] 61.9% (122/197) 68.0% (102/150) 42.6% (20/47) 5.1% (10/197) 4.8 [4.0, 5.3] 5.1 [4.7, 8.4]
P-value 0.61 <0.001 0.09 0.48 0.002 0.07 0.53 0.03