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Adjunctive Procedures (thrombectomy, atherectomy, special balloons)
Acute and Mid-Term Results of Percutaneous Coronary Intervention with Orbital Atherectomy System
Jumpei Koike1, Atsushi Funatsu1, Tomoko Kobayashi1, Shigeru Nakamura1
Kyoto Katsura Hospital, Japan1
Severely calcified lesions present many challenges to percutaneous coronary intervention (PCI). Recently, a newly developed atherectomy device, Coronary Orbital Atherectomy system (OAS) has been approved.
141 consecutive cases (173 lesions) who underwent PCI with OAS in Kyoto Katsura Hospital from February 2018 to August 2019 were enrolled. We assessed the clinical outcomes after OAS of severely calcified lesions; procedure success, angiographic complications, In-hospital MACE (Cardiac death, Myocardial Infarction (MI: CK > 10ĄżULN ), and Target Vessel / Lesion Revascularization (TVR/TLR)) and mid-term results at 6 months after PCI. Restenosis factors were also examined. We compared the difference in procedure and lesion factors between the restenosis lesions and no restenosis lesions.
Mean age was 78 years and 72% patients were male. Coronary risk factor hypertension (81%), hyperlipidemia (67%), diabetes (50%), smokers (15%), CKD (38%) and Hemodialysis (13%). Optical Frequency Domain Imaging (OFDI) was used as imaging device in 73% of all patients. We performed OAS at low revolution speed in all cases and made an addition at high revolution speed in71% lesions. 11% lesions additionally needed rotational atherectomy because OAS could not pass through the lesion or the lesion needed additional ablation with large rotational atherectomy bar. 83% lesions were finally treated with drug coated balloon (DCB), and stents were implanted in 12% lesions.  Procedural success rate was 97%. In complications, coronary perforation occurred in 1% lesion, persistent slow flow in 2%. Overall free from In-hospital MACE was 97%. There were 1 cardiac death (2%), 3 non Q-MI (2%) and no TLR. Follow up angiography was performed in 54 of 85lesions (62%) we eligible follow up at 6 months. Restenosis was observed in 5lesions (9%). There was no significant difference in Final device, predilatation balloon and occurrence of slow flow between 5 lesions with restenosis and 49 lesions without restenosis.
In a large proportion of lesions treated by DCB (83%), 9% restenosis in mid-term clinical result was acceptable. OAS as a lesion preparation tool may offer a new treatment for the patients with severely calcified lesions. However, 11% lesions needed additional ablation with rotational atherectomy. It is necessary to examine further which lesions are suitable for OAS.
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