Atherectomy for calcified plaques: orbital for most? Pros and cons

Plaque modification techniques are crucial for the optimal treatment of calcified coronary lesions. Among these techniques, atherectomy plays an important role by enabling the crossing of very tight stenoses and facilitating stent implantation and optimal expansion. Currently, two atherectomy tools are available in clinical practice: rotational atherectomy (RA), which has been extensively investigated for nearly four decades; and orbital atherectomy (OA), a more recent addition to the field. Orbital atherectomy consists of a drive shaft eccentrically mounted on a diamond-coated crown, offering technical advantages over rotational atherectomy, including, but not limited to, its bidirectional ablating potential. However, the evidence supporting orbital atherectomy is still relatively limited, and no head-to-head comparisons with RA have been conducted to evaluate clinical outcomes. The question of whether OA should be the preferred option for atherectomy in most patients with calcified coronary lesions remains open and subject to ongoing debate.

Ajay J. Kirtane, MD, SM

Coronary atherectomy devices are essential adjunctive tools for modifying severely calcified lesions in percutaneous coronary intervention (PCI). Originally developed decades ago to work in lieu of balloon angioplasty, these...