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We report the clinical outcomes of patients who underwent percutaneous coronary intervention (PCI) with orbital atherectomy for severely calcified unprotected left main coronary artery (ULMCA) disease. Although coronary artery bypass grafting is the gold standard for patients with ULMCA disease not all patients are candidates for this. PCI is increasingly used to treat complex coronary artery disease, including ULMCA disease. The presence of severely calcified lesions increases the complexity of PCI. Orbital atherectomy can be used to facilitate stent delivery and expansion in severely calcified lesions. The clinical outcomes of patients treated with orbital atherectomy for severely calcified ULMCA disease have not been reported.
From May 2014 to July 2015, 13 patients who underwent PCI with orbital atherectomy for ULMCA disease were retrospectively evaluated. The primary end point was major cardiac and cerebrovascular events (cardiac death, myocardial infarction, stroke, and target lesion revascularization) at 30 days.
The mean age was 78.2 ± 5.8 years. Left ventricular dysfunction was present in 46.2%. Cardiac surgery declined surgical revascularization in 61.5%. Distal bifurcation disease was present in 69.2%. Procedural success was achieved in 100% of patients. The 30-day major adverse cardiac and cerebrovascular event rate was 0%. One patient had coronary dissection which was successfully treated with stenting. One patient died from non-cardiac cause (7.7%). No patient had perforation, slow flow, or thrombosis.
Orbital atherectomy is a safe and effective treatment strategy for patients with severely calcified ULMCA disease, even in high-risk patients who were considered poor surgical candidates.