The dual mechanism of action during orbital atherectomy on intravascular ultrasound images
█ Case Report
Hajtman László, Duray Gábor, Kerecsen Gábor
Észak-Pesti Centrumkórház – Honvédkórház, Kardiológia Osztály, Budapest
Dr. Hajtman László, e-mail: firstname.lastname@example.org
Percutaneous coronary intervention (PCI) has growing success, but extensive, severe coronary calcification remains a challenge. In those cases plaque modifying devices are frequently needed. The new, orbital atherectomy system has just become available in Hungary. This device -according to the promise of the vendor- has dual mechanism of action, as bi-directional differential sanding atherectomy, and pulsation force, which can reduce superficial calcium burden and may cause some fractures in deeper calcified layers.
Our first case was an 84 years old male patient, with hypertension, diabetes, atrial fibrillation, hypothyroidism, peripheral artery disease, mildly impaired renal function and a history of ischemic stroke. He admitted by CCS 3 angina with progression. On coronarography left circumflex artery (LCX) was occluded, and left anterior descending artery (LAD) had focal stenosis at the proximal part. Right coronary artery was extensively calcified, with a focal subocclusion at the middle segment. Laesion modification by orbital atherectomy was performed anterograde and retrograde direction several times on the RCA. In order to evaluate the laesion modification intravascular ultrasound (IVUS) imaging was performed after the atherectomy that showed not only the superficial sanding of the luminal calcium, but also fracture of the deep calcium layers at several locations. After implanting two coronary stents significant coronary dissection, no-reflow or distal embolism did not occur, according to the IVUS the stents were well apposed with an acceptable minimal stented area.
The outcome of PCI is affected by complex, calcified lesions. The dual mechanism of action of the orbital atherectomy was proved in the current case and the device indeed fractured deep calcium layers. By this effect orbital atherectomy has a good chance to improve the long term success of coronary interventions in severely calcified vessels.
ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 1
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