Feasibility and Safety of Orbital Atherectomy for the Treatment of In-Stent Restenosis
Neupane S, Basir M, Tan C, Tabaku M, Alqarqaz M, Khandelwal A, O'Neill W, Don C, and Alaswad K. FEASIBILITY AND SAFETY OF ORBITAL ATHERECTOMY FOR THE TREATMENT OF IN-STENT RESTENOSIS. J Am Coll Cardiol 2019; 73(9):1153.
J Am Coll Cardiol
Background: Debulking and ablative techniques are used for the treatment of in-stent restenosis (ISR). The safety and efficacy of orbital atherectomy (OA) in this cohort of patients has not been reported. Methods: We retrospectively evaluated procedural as well as clinical outcomes in patients treated with OA for ISR secondary to underlying calcific disease at two academic tertiary care centers from Oct 2016 to Sept 2018. Results: A total of 38 patients underwent OA for ISR during the period with mean age 66 +/- 12 yrs; 74% male, 63% diabetic, 39% post-CABG and 61% with a prior incident of ISR. Patients presented with NSTEMI (32%), unstable angina (18%) and stable angina (50%). Implantation of culprit stent occurred between 4 months to 22 years prior to the index procedure. The severity of ISR according to the Mehran classification; type 1 (24%), 2 (26%), 3 (18%) and 4 (32%). Angioplasty prior to OA was performed in 45% of cases and post OA in 95% of cases. Intracoronary imaging was performed in 79% of cases. There was one (3%) periprocedural MI from no reflow phenomenon. There was one (3%) Ellis type II coronary perforation thought to be related to aggressive post OA angioplasty that resulted in no measurable clinical sequelae. There were no reports of equipment malfunction or harmful device/stent interactions. Conclusion: OA can be safely performed as an adjunctive tool in the treatment of ISR. Caution must be taken in these high risk lesions to limit complications and harmful device/stent interactions.
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