Orbital atherectomy does not yield greater minimal stent area or reduce rate of target vessel failure at one year
By Elana Gotkine HealthDay Reporter
MONDAY, Nov. 4, 2024 (HealthDay News) — For patients with severely calcified coronary lesions, routine treatment with orbital atherectomy prior to drug-eluting stent implantation does not yield greater minimal stent area or reduce the rate of target vessel failure compared with conventional balloon angioplasty, according to a study presented at the annual Transcatheter Cardiovascular Therapeutics conference, held from Oct. 27 to 30 in Washington, D.C.
Ajay J. Kirtane, M.D., from the Columbia University Medical Center in New York City, and colleagues randomly assigned 2,005 patients with 2,492 severely calcified coronary lesions at 104 sites to routine treatment with orbital atherectomy (1,008 patients) or conventional balloon angioplasty (997 patients) prior to percutaneous coronary intervention with drug-eluting stents.
The researchers found that the minimal stent area at the site of maximal calcification was 7.67 ± 2.27 mm2 and 7.42 ± 2.54 mm2 in the orbital atherectomy and balloon angioplasty groups, respectively (mean difference, 0.26 mm2). Target-vessel failure occurred in 114 and 95 patients in the orbital atherectomy and balloon angioplasty groups, respectively (one-year Kaplan-Meier estimates, 11.6 and 9.8 percent, respectively; hazard ratio, 1.19).
“Routine use of orbital atherectomy did not lead to greater stent expansion or improve one-year patient outcomes compared to routine balloon angioplasty prior to stenting,” study chair Gregg W. Stone, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, said in a statement. “Therefore, the use of orbital atherectomy may be reserved for the most extreme cases for which the operator does not believe that balloon angioplasty would be likely to safely cross or predilate the calcified lesion.”
The study was funded by Abbott Vascular.
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