Orbital atherectomy for calcified nodule: optical coherence tomography assessment

Abstract

We present the case of a 91-year-old man with a past medical history of moderate-to-severe aortic stenosis referred due to breathlessness. The routine invasive coronary angiography performed before transcatheter aortic valve replacement confirmed the presence of a severely calcified left anterior descending coronary artery proximal segment (figure 1A; video 1 of the supplementary data). The functional assessment performed showed a fractional flow reserve of 0.79. The optical coherence tomography (OCT) interrogation revealed an arc of calcium > 180°, thickness of 0.6 mm, and length > 5 mm with a calcified nodule with a minimum lumen area of 3.49 mm2 (figure 1C; video 2 of the supplementary data). Orbital atherectomy with the Diamondback 360 Coronary OAS (Cardiovascular Systems, Inc., United States) was selected to prepare the lesion. After 5 runs at low speed (80 000 rpm), a new OCT was performed that confirmed the fracture of the calcified nodule achieving a minimum lumen area of 7.5 mm2 (figure 1D; video 3 of the supplementary data). Consecutively, a 2.5 mm x 15 mm SC balloon (OrbusNeich, China) plus a 3.0 mm x 10 mm NC balloon (Medtronic, United States) were advanced through the lesion and inflated twice. Finally, a Megatron 3.5 mm...