MECHANISM OF ACTION OF ORBITAL ATHERECTOMY IN SEVERELY CALCIFIED CORONARY ARTERIES: INSIGHTS FROM A CADAVERIC PERFUSION MODEL
Publication Title
Journal of the American College of Cardiology
Document Type
Article
Publication Date
3-4-2019
Abstract
Background: Orbital atherectomy (OA) is indicated for facilitating stent delivery in patients by reducing coronary plaque, but complete understanding of the therapeutic mechanism has not been established. We performed a mechanistic study using a cadaveric heart perfusion model to investigate the impact of OA on heavily calcified coronary arteries.
Methods: Five perfused cadaveric human coronaries with calcified stenoses were evaluated with angiography and Optical Coherence Tomography (OCT) to determine regions of interest (ROI). A single OA run was performed on low speed for 30 seconds over the ROI followed by a post OCT run. Movat-Russell pentachrome (MvP) stain images were co-registered to the post OA OCT run.
Results: [A] shows the caged angiograms of an artery pre OA. The ROI was selected to be 30-40mm (lighter shaded band). [B] and [C] show the OCT images pre and post OA. In [B], a post-mortem dissection is observed (*) and co-identified in [C] and [D]. A single luminal calcified sheet (···) is visible in [B]. Following OA application, a novel radial dissection is visible (^) while the calcified sheet (···) appears unaffected. MvP staining confirms the presence of the dissection (^) and the undisrupted calcified sheet (···), a finding identified in the other four calcified segments.
Conclusion: In a cadaveric model of calcified coronary arteries, segments treated with OA at low speed demonstrated radial dissections along fibrotic tissue planes. Calcified tissue was not found to be abraded within this sample set.
Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Comments
Drs. Hagen and Petersen are affiliated with Providence St. Joseph Health.