Procedural and Clinical Outcomes After Orbital Atherectomy Versus Intravascular Lithotripsy in Patients With Calcified Nodules

作者：Ali Dakroub, Doosup Shin, Mandeep Singh, Sarah Malik, Rick Volleberg, Jonathan Weber, Yasemin Ciftcikal, Alysse Fazal, Koshiro Sakai, Takao Sato, Akiko Maehara, Mitsuaki Matsumura, Jeffrey W. Moses, Gary S. Mintz, Omar Khalique, Fernando Karel Fonseca Sosa, Evan Shlofmitz, Allen Jeremias, Richard Shlofmitz, Ziad A. Ali · 发表于：Circulation Cardiovascular Interventions · 年份：2025 · DOI：10.1161/circinterventions.125.015254 · 被引用次数：4 · 研究领域：Coronary Interventions and Diagnostics、Retinal Diseases and Treatments、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Calcified nodules (CNs) remain a major challenge in percutaneous coronary intervention (PCI). We sought to compare procedural and clinical outcomes after orbital atherectomy (OA) versus intravascular lithotripsy (IVL)-facilitated PCI in patients with CNs. METHODS: We identified patients with optical coherence tomography (OCT)-defined CNs who underwent PCI with either OA or IVL between 2012 and 2022 and had both pre- and post-PCI OCT images available. The imaging end point was the minimal stent area on final post-PCI OCT. The clinical end point was 2-year target-lesion failure, a composite of cardiac death, target-vessel myocardial infarction, or clinically driven target-lesion revascularization. A multivariable Cox proportional hazards regression model was used to estimate hazard ratio and 95% CI. Sensitivity analyses were performed using propensity score matching, incorporating covariates such as age, sex, diabetes, and pre-PCI calcium burden assessed by OCT (length, arc, and thickness). RESULTS: Among 4856 patients with evaluable pre- and post-PCI OCT images, 493 patients (10.2%) had CNs, and 167 patients underwent PCI with either OA (n=83) or IVL (n=84). The 2 groups had similar baseline demographic and lesion characteristics. After PCI, final minimal stent area was comparable between the 2 groups (OA, 5.6 mm 2 [interquartile range, 4.8–6.7] versus IVL, 5.5 mm 2 [interquartile range, 4.8–7.0]; P =0.75). At a median follow-up of 2.4 years, there was no differenc...