Manasrah Nouraldeen, Zghouzi Mohamed, Naughton Ryan, Patel Dhruvil, Osman Heba, Abdelrahman Ahmad K, Halboni Adnan, Deschamps Raegan, Sattar Yasar, Alraies M Chadi
Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA.
Internal Medicine, Detroit Medical Center, Detroit, USA.
Cureus. 2023 Apr 16;15(4):e37651. doi: 10.7759/cureus.37651. eCollection 2023 Apr.
Background Orbital atherectomy (OA) is used to prepare severely calcified coronary artery lesions before percutaneous coronary intervention (PCI). Intravascular ultrasound (IVUS) is used to determine the plaque volume and degree of stenosis within the arterial vessel. This study evaluated the safety and efficacy of OA for treating severely calcified coronary lesions and determined if IVUS impacted these outcomes. Methods We retrospectively collected data from a single center of patients with severe coronary artery calcification who underwent OA. The data on baseline characteristics and procedural and clinical outcomes were collected and analyzed. Results A total of 374 patients underwent OA. The mean age was 69 ± 12.7; 53.6% were Black, and 38% were female. Hypertension was present in 96% of the patients, followed by hyperlipidemia in 79.4%, diabetes mellitus in 53.7%, and chronic kidney disease (CKD) in 22.7%. More patients had presented with a non-ST-elevation myocardial infarction (NSTEMI) compared to ST-elevation myocardial infarction (STEMI) at 36.3% versus 4.3%, respectively. The radial artery was used in 35.4% of the cases, and the left anterior descending artery (LAD) was the most commonly treated vessel with OA at 61%, followed by the right coronary artery (RCA) at 30.7%. IVUS was utilized in 63.4% of cases. The most common complication of the procedure was perforation and dissection at an equal proportion of 1.3% among all patients. The no-reflow rate was 0.5%, and 0.5% developed post-procedural myocardial infarction (MI). The average length of stay was 4.7 days, while a marginal proportion, at 10.5%, had same-day discharge with no recorded complications. Conclusion In this analysis of patients with severely calcified coronary lesions, OA had low rates of major adverse cardiovascular events (MACE) and was considered a safe and effective treatment for complex coronary lesions.
冠状动脉旋磨术（OA）用于在经皮冠状动脉介入治疗（PCI）前处理严重钙化的冠状动脉病变。血管内超声（IVUS）用于确定动脉血管内的斑块体积和狭窄程度。本研究评估了OA治疗严重钙化冠状动脉病变的安全性和有效性，并确定IVUS是否会影响这些结果。方法：我们回顾性收集了来自单一中心接受OA治疗的严重冠状动脉钙化患者的数据。收集并分析了基线特征、手术和临床结果的数据。结果：共有374例患者接受了OA治疗。平均年龄为69±12.7岁；53.6%为黑人，38%为女性。96%的患者患有高血压，其次是79.4%的高脂血症、53.7%的糖尿病和22.7%的慢性肾脏病（CKD）。与ST段抬高型心肌梗死（STEMI）相比，更多患者表现为非ST段抬高型心肌梗死（NSTEMI），分别为36.3%和4.3%。35.4%的病例使用桡动脉，左前降支（LAD）是OA治疗最常见的血管，占61%，其次是右冠状动脉（RCA），占30.7%。63.4%的病例使用了IVUS。该手术最常见的并发症是穿孔和夹层，在所有患者中的比例均为1.3%。无复流率为0.5%，0.5%的患者发生术后心肌梗死（MI）。平均住院时间为4.7天，10.5%的小部分患者在无并发症记录的情况下当天出院。结论：在这项对严重钙化冠状动脉病变患者的分析中，OA的主要不良心血管事件（MACE）发生率较低，被认为是治疗复杂冠状动脉病变的安全有效方法。
