"Single-Operator" Technique for Advancing the Orbital Atherectomy Device

Objective. We assessed the feasibility and safety of the "single-operator" technique in which the operator autonomously advanced the orbital atherectomy (OA) device while maintaining wire position. Background. Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI), and is associated with lower procedural success rates and higher rates of adverse outcomes, including death, myocardial infarction, target-vessel revascularization, and stent thrombosis. OA is an effective treatment strategy to facilitate optimal stent expansion. Reluctance with the utilization of OA may stem from operator inexperience, unavailability of an experienced assistant, and the potential for proximal and distal wire migration during advancement of the device, leading to increased procedural and fluoroscopic time. Methods. Fifty consecutive patients who underwent OA from February 2014 to September 2016 were included in this prospective study. The primary endpoint was successful delivery of the OA device to the lesion while maintaining distal wire position and procedural success. Results. The primary endpoint was achieved in all 50 patients (100%). The 30-day major adverse cardiac and cerebrovascular event rate was 6.0%, due to death (2%) and myocardial infarction (4%). Target-vessel revascularization, stroke, and stent thrombosis did not occur. Perforation occurred in 2%. Slow-flow occurred in 4%, but resolved with intracoronary vasodilator therapy and achieved Thombolysis in Myocardial Infarction grade 3 flow. Flow-limiting dissection did not occur. Conclusion. The single-operator technique is feasible, can be used to maintain wire position while the OA device is advanced, and obviates the need for a skilled assistant when advancing the OA device.