Scifed International Expo on Cardiology-2018

Coronary atherectomy in severely calcified lesions

Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major adverse cardiovascular events. CAC can usually be found in patients with severe CHD and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary intervention have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients.

The atherectomy devices that are currently commercially available differ by design and mechanism of action. The unique mechanisms of action help to determine which device is best suited for different types of lesions. The following sections provide an overview of these atherectomy modalities, with a particular focus on rotational and orbital atherectomy, as they are the two modalities in current use for severely calcified coronary lesions to facilitate stent delivery.

Laser atherectomy has been used in the clinical setting since 1983.10 The ELCA coronary laser atherectomy catheter (Spectranetics Corporation) delivers a high-energy light beam via a specialized catheter with short pulses, vaporizing thrombi, and debulking plaque. 

Directional coronary atherectomy (DCA) was approved for use by the US Food and Drug Administration (FDA) in 1990.14 A DCA catheter is equipped with a rotating cutter that ablates plaque through a small window with the assistance of an inflated balloon. The rotating cutter is advanced distally, ablating the lesion and aspirating the debris.

Transluminal extraction catheter (TEC) atherectomy simultaneously excises and extracts plaque and thrombi15 and received FDA approval in 1993. TEC was used to treat lesions of heterogeneous morphology and in bypass grafts prior to angioplasty. TEC is no longer commercially available.

Rotational atherectomy was first used in 1988 and uses high-speed (140,000–180,000 rpm) rotation to ablate inelastic plaque, resulting in debris with an average size of < 5 μm.16 Rotational atherectomy has been the most commonly used atherectomy modality to date. It is commercially available as the Rot-ablator atherectomy system (Boston Scientific Corporation) and incorporates a diamond-tipped elliptical burr, which spins concentrically as it advances in a forward direction.

Cardiology-2018 conference is providing excellent opportunity for the people related to “Coronary atherectomy” to meet experts, exchange information, and strengthen the collaboration among Directors, Researchers, Associate Professors, and Scholars from both academia and industry.

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