To evaluate the clinical outcomes of patients with coronary artery disease (CAD) who underwent rotational atherectomy (RA) and orbital atherectomy (OA).

Selection process of articles were done systematically according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) and PICO criteria for publication in the last 5 years.  Keywords were searched by Boolean operator. STROBE checklist was used to assess the quality of all selected articles. 

Five articles of non-randomized observational analysis were selected, which involved 72.982 patients whom underwent RA, while 6.431 others underwent OA which is a new atherectomy method that was approved for use in coronary arteries in 2003. Although some studies still showed varying results due to different data collection tools, overall data showed there was no difference between the two techniques in terms of contrast volume, outcomes of coronary artery dissection, device induced arterial perforation, cardiac tamponade, slow flow/no reflow, periprocedural myocardial infarction (MI), in-hospital mortality, 30-day mortality, 30-day MI, 30-day target vessel revascularization (TVR), and 30-day major adverse cardiovascular events (MACE).  Although complication rates may be dependent on the use of some preventive measures proposed by experts including appropriate burr size and rotational speed for RA.

Except for lower fluoroscopy time with OA, there are no significant differences between OA and RA in relation to procedural, periprocedural, and thirty day outcomes among patients with calcified CAD undergoing PCI.