(CCSP017) INITIAL EXPERIENCE WITH THE USE OF ORBITAL ATHERECTOMY FOR CORONARY CALCIUM MODIFICATION

Background: Treatment of calcified coronary arteries remains challenging despite advances in calcium modification techniques. Orbital Atherectomy is a recently Health Canada approved technology for coronary calcium modification. We report our experience with this technology at our centre.

METHODS AND RESULTS: Data were collected for twenty-two patients treated with Orbital Artherectomy between March 2022 and April 2023. The database included patient characteristics, procedural characteristics, procedural success rate and complications.

Twenty-two patients were treated with Orbital Atherectomy by 6 interventional cardiologists during this 13-month period. Patients were between ages 61-87, the mean age was 68.9 years and 68% were males. Indication for intervention was acute coronary syndromes in 6 patients (27.3%) and stable angina in 16 patients (72.7%). Peer review with company support was mandated to determine suitability of orbital atherectomy after the index angiogram in 14 procedures. Overall, 17 procedures (77.2%) were planned and 5 (22.7%) received orbital atherectomy treatment during the initial procedure in an ad hoc manner. Sixteen patients (72.7%) were discharged home within 24 hours. Hypertension was present in 90.9% of patients, dyslipidemia in 81.8%, diabetes in 63.6%, and chronic kidney disease in 22.7%. All lesions treated with Orbital Atherectomy were within the native artery lesions while two patients had prior CABG. Femoral access was used in 4 cases and 18 cases used radial access. Orbital Atherectomy was performed in the LAD (55.5%), LCx (13.6%) and RCA (31.8%). All lesions were pre-dilated with semi-compliant or non-compliant balloons. After Orbital Atherectomy, non-compliant balloons were used in 22 patients (100%), OPN was required in 1 patient (4.5%), adjuvant rotational atherectomy was not needed in all patients.

Angiographic success defined by less than 20% residual stenosis was achieved in 20 lesions (90.9%) and 1 lesion required an OPN balloon. A stent was successfully deployed in all patients. Complications occurred in 2 patients. One case was complicated by an extended coronary dissection requiring three additional stents and subsequent peri-procedural MI. The second case was complicated by the occlusion of a diagonal branch which was treated medically resulting in a peri-procedural MI.

Conclusion: Coronary calcium modification using Orbital Atherectomy is effective in facilitating stent expansion. Success rate was high and procedural complications were low.