Use of orbital atherectomy treatment in a high-volume clinical practice modifies non-compliant plaque to deliver durable long-term results.

BACKGROUND: Resistant fibrotic calcified plaque is a major limitation in treating peripheral arterial disease (PAD). Percutaneous transluminal angioplasty (PTA) balloon pressures of 8-16 atm are typically required in these lesions. Ultrasound has detected significant dissection or plaque fracture immediately after balloon dilation in 76% of patients. Endovascular techniques are available that remove calcified plaque and alter lesion compliance, which minimizes dissection and stenting. A single-center experience evaluating the long-term durability of calcified plaque removal utilizing orbital atherectomy is presented.
METHODS: Patients with PAD underwent primary intervention with orbital atherectomy followed by low-pressure balloon angioplasty. Lesion compliance markers, including balloon inflation pressures and times, dissection rates, and bail-out stent rates, were recorded. Twelve-month re-intervention rates were also tracked.
RESULTS: Forty-six patients (57 lesions) were treated. Average age was 71 years and 74% of the patients were male. Rutherford classification was 3 to 5 for all patients. Lesion locations were in the common femoral artery (9%), superficial femoral artery (56%), popliteal artery (19%), and tibial/peritoneal arteries (16%). Average pretreatment stenosis was 90%. Adjunctive PTA was utilized in 82.5% of the lesions. Mean maximum inflation pressure was 5 atm for a mean of 2.3 minutes. Mean residual stenosis was 11%. One dissection occurred and no bailout stenting was required. Five patients (10.9%) returned for target lesion re-treatment.
CONCLUSION: Orbital atherectomy modifies calcified lesion compliance in resistant peripheral arterial plaques as demonstrated by low balloon inflation pressures of short duration. Bail-out stenting was eliminated. Results were durable and the re-intervention rate was low.