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One-Year Outcomes of Orbital Atherectomy of Long, Diffusely Calcified Coronary Artery Lesions Procedural Success and Outcomes With Increasing Use of Enabling Strategies for Chronic Total Occlusion Intervention Treatment Effects of Pulmonary Artery Denervation for Pulmonary Arterial Hypertension Stratified by REVEAL Risk Score: Results from PADN-CFDA Trial Italian Society of Interventional Cardiology (GIse) Registry Of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO): Impact of Valve Disease Etiology and Residual Mitral Regurgitation after MitraClip Implantation Mechanistic Biomarkers Informative of Both Cancer and Cardiovascular Disease: JACC State-of-the-Art Review Temporal changes in radial access use, associates and outcomes in patients undergoing PCI using rotational atherectomy between 2007 and 2014: results from the British Cardiovascular Intervention Society national database 5-Year Outcomes of PCI Guided by Measurement of Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve Venous and Arterial Thromboembolism in Patients With Cancer: JACC: CardioOncology State-of-the-Art Review Pathophysiology, diagnosis and new therapeutic approaches for ischemic mitral regurgitation Transcatheter Interventions for Tricuspid Valve Disease: What to Do and Who to Do it On
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Clinical Trial2018 Jun;30(6):230-233.

JOURNAL：J Invasive Cardiol. Article Link

One-Year Outcomes of Orbital Atherectomy of Long, Diffusely Calcified Coronary Artery Lesions

Lee MS, Shlofmitz E, Lluri G et al. Keywords: coronary calcium, orbital atherectomy

ABSTRACT

OBJECTIVES - The aim of this study was to determine the clinical outcomes of patients with long, diffusely calcified coronary artery lesions who underwent orbital atherectomy.


BACKGROUND - The presence of severe coronary artery calcification increases the complexity of percutaneous coronary intervention. Orbital atherectomy of long, diffusely calcified lesions may increase the risk of periprocedural angiographic complications. Furthermore, the rate of ischemic complications, including target-vessel revascularization (TVR), in these long, calcified lesions is historically high.

METHODS - In this retrospective multicenter registry, which included 458 real-world patients who underwent orbital atherectomy, a total of 154 patients (33.6%) required a total stent length of ≥50 mm (long-stent group). The primary endpoint was the 1-year major adverse cardiac and cerebrovascular event (MACCE) rate, defined as the composite of death, myocardial infarction, TVR, and stroke.

RESULTS - The long stent group had a higher rate of perforation (1.9% vs 0.0%; P=.01) and dissection (2.6% vs 0.0%; P<.01). The primary endpoint was similar in the long and short groups (14.2% vs 11.5%, respectively; P=.40), as were the 1-year rates of death (2.6% vs 4.6%, respectively; P=.30), myocardial infarction (1.9% vs 1.6%, respectively; P=.80), TVR (9.7% vs 6.3%, respectively; P=.18), and stroke (1.3% vs 1.3%, respectively; P>.90). The stent thrombosis rate was similar in both groups (1.3% vs 1.3%; P>.90).

CONCLUSIONS - Despite the higher angiographic complication rates, orbital atherectomy of long, diffusely calcified lesions was associated with acceptable rates of ischemic complications in this challenging lesion subset at 1-year follow-up.
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