title: Optical coherence tomography assessment of the mechanistic effects of rotational and orbital atherectomy in severely calcified coronary lesions.
abstract: OBJECTIVE
  This study sought to assess the mechanistic effect of rotational atherectomy (RA) and orbital atherectomy (OA) on heavily calcified coronary lesions and subsequent stent placement using optical coherence tomography (OCT).
  
  
  BACKGROUND
  RA and OA are two main approaches to ablate coronary calcium. While small case reports have described the mechanistic effect of RA in calcified coronary lesions, there has been no imaging study to assess the effect of OA on coronary artery architecture and/or compare the effects of two atherectomy devices.
  
  
  METHODS
  This study analyzed 20 consecutive patients with OCT imaging performed after atherectomy and after stent implantation, RA (n = 10) and OA (n = 10).
  
  
  RESULTS
  Postatherectomy OCT analysis identified tissue modification with deep dissections in around a third of lesions after RA and OA; however, post OA dissections ("lacunae") were significantly deeper (1.14 vs. 0.82 mm, P = 0.048). Post OA/RA lesions with dissections had significantly higher percentage of lipid rich plaques and smaller calcification arcs as compared to plaques without dissections. Stents after OA were associated with a significantly lower percent of stent strut malapposition than post RA stents (4.36 vs. 8.02%, P = 0.038).
  
  
  CONCLUSIONS
  Although the incidence of dissections was comparable between RA and OA cases, OA resulted in deeper tissue modifications (lacunae) as shown by OCT imaging. The finding might provide an explanation for a better stent apposition after OA as compared to RA. Their impact on long-term outcome needs to be determined.
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Vengrenyuk
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Pena
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sadako
authors.initials: S
authors.lastname: Motoyama
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Feig
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Meelu
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Anitha
authors.initials: A
authors.lastname: Rajamanickam
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Arjun M
authors.initials: AM
authors.lastname: Bhat
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sadik
authors.initials: S
authors.lastname: Panwar
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D017073:Atherectomy / Q000379:methods; D017225:Atherectomy, Coronary / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy
keywords: atherectomy; coronary artery calcification; optical coherence tomography