Utilizing intravascular ultrasound imaging prior to treatment of severely calcified coronary lesions with orbital atherectomy: An ORBIT II sub-analysis

作者：Shlofmitz Evan; Martinsen Brad; Lee Michael; Genereux Philippe; Behrens Ann; Kumar Gautam; Puma Joseph; Shlofmitz Richard; Chambers Jeffrey

来源：Journal of Interventional Cardiology, 2017, 30(6): 570-576.

DOI：10.1111/joic.12423

• calcification
• intravascular ultrasound imaging
• orbital atherectomy
• percutaneous coronary intervention

Objectives: We sought to assess the clinical outcomes when intravascular ultrasound (IVUS) was used prior to orbital atherectomy treatment (OA) versus angiography alone for lesion assessment.
Background: Percutaneous coronary intervention (PCI) of severely calcified lesions is associated with high rates of major adverse cardiac events (MACE). IVUS provides additional diagnostic information to optimize PCI.
Methods: ORBIT II was a single-arm study of 443 patients with de novo, severely calcified coronary lesions treated with OA before stent placement. Patients with IVUS imaging prior to OA (N = 35) were compared to patients without IVUS imaging for initial lesion assessment (N = 405). In this post-hoc sub-analysis procedural outcomes and the 3-year MACE rate were evaluated.
Results: The rates of severe angiographic complications were low in patients with and without IVUS imaging prior to OA. There was a significant reduction in the number of stents used in patients with IVUS imaging prior to OA (1.0 +/- 0.2 vs 1.3 +/- 0.6; P = 0.006) and increased post-OA mean minimal lumen diameter (MLD) (1.6 +/- 0.6 mm vs 1.2 +/- 0.5 mm; P < 0.001). The 3-year MACE rate was similar in both groups (IVUS: 14.3% vs No IVUS: 24.2%; P = 0.26).
Conclusions: There were significantly fewer stents placed, increased post-OA MLD, and similar 3-year MACE outcomes in patients with IVUS assessment of the degree of lesion calcification prior to OA as compared to patients with angiographic assessment of the degree of lesion calcification. Further studies are needed to determine the optimal integration of intravascular imaging with OA.