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One Year Outcomes of Orbital versus Rotational Atherectomy for the Treatment of Heavily Calcified Coronary Disease

Milad El Hajj, Andrew Hill, Stephanie El Hajj, Spenser Staub, Valerian Fernandes, Anbukarasi Maran

Objectives: Compare long term outcomes between orbital versus rotational atherectomy for the treatment of heavily calcified coronary disease at a single institution.

Background: Plaque modification with atherectomy facilitates stent delivery and optimization in severely calcified coronaries. Rotational Atherectomy (RA) (Boston Scientific) has been in use for several decades while orbital atherectomy (OA) (CSI Diamondback 360®) is a newer atherectomy device that is rapidly gaining momentum. Small trials and meta-analyses have compared these 2 devices; however, longer term outcomes have not been evaluated.

Methods: We retrospectively identified 75 patients who underwent RA or OA, and had at least 1-year follow up, at a single veteran center from March 2016 to October 2017. The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE) (composite of all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), and stroke). The secondary endpoint was cardiovascular death at 1 year.

Results: Out of 75 patients, 46 underwent 54 unique RA procedures and 28 underwent 28 unique OA procedures. More patients in the RA group had a prior MI (45.8% vs. 20.7%, p=0.03). Otherwise, baseline demographics and comorbidities were similar in both groups. Procedural success was achieved in all patients. Angiographic complications were uncommon. There was no statistically significant difference in the primary endpoint at one year between RA and OA groups (26% vs. 11%, p=0.14), respectively, as well as the individual components of all-cause-mortality (13% vs. 7%, p=0.70), MI (11% vs. 0%, p=0.15), TVR (13% vs. 7%, p=0.71), and stroke (0% vs. 4%, p=0.38). No significant difference in cardiovascular death was observed at 1 year (9% vs. 4%, p=0.64).

Conclusion: Both RA and OA are safe and effective in treating severe coronary artery calcification as they provide similar outcomes at 1 year