Overview
Dr. Emmanouil Brilakis used orbital atherectomy in the treatment of a severely calcified LAD.
Dr. Emmanouil Brilakis used orbital atherectomy in the treatment of a severely calcified LAD.
A 71-year-old man with a history of hypertension and tobacco use presented with NSTEMI and LVEF 20%. There was a history of severe left iliac disease. Coronary angiography performed included Right Coronary Artery (RCA) Chronic Total Occlusion (CTO), mid Left Anterior Descending (LAD) CTO, and Obtuse Marginals (OM) 1 CTO. Cardiogenic shock resulted in Intra-aortic Balloon Pump (IABP) use and weaned off.
The MRI showed viable myocardium and the patient was referred for high risk percutaneous cardiovascular intervention (PCI).
The patient was admitted for a right heart catheterization. The pulmonary capillary wedge pressure (PCWP) was 26 mmHg, with a mean pulmanory artery pressure measuing at 29 mmHg. Left femoral access was gained for insertion of an Impella but with difficulty advancing the guidewire.
The severely calcified Left Anterior Descending (LAD) was accessed by using a guidewire to advance into the distal diagonal branch, and a microcatheter advanced to the origin of the first diagonal. Guidewire crossing was easy, but balloons were unable to cross. The guidewire was exchanged for the ViperWire Advance® Coronary Guide Wire with Flex Tip and the Diamondback 360® Coronary Orbital Atherectomy System (OAS) was advanced to the lesion. Multiple runs were done with the OAS.
The lesion was rewired successfully with the guidewire and dilated with a 2.0 mm balloon. Multiple balloon inflations were done in the LAD (2.0, 2.5, and 3.0 mm balloons). 2.5 x 28 mm drug-eluting stent (DES) and 2.75 x 38 mm DES were deployed, with a 3.0 x 18 mm DES expanded proximally. A staged PCI of Left Circumflex Artery (LCX) was planned 1-2 months follwing this procedure.
Orbital Atherectomy allowed the physician the ability to treat multiple vessel sizes with a single crown.
Successful PCI was achieved using Orbital Atherectomy to modify the severely calcified lesions and to allow for successful facilitation of multiple stents.
High-risk PCI can be safely performed with Orbital Atherectomy to help optimize stent expansion and apposition.
Indications Statement: The Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a percutaneous orbital atherectomy system indicated to facilitate stent delivery in patients with coronary artery disease (CAD) who are acceptable candidates for PTCA or stenting due to de novo, severely calcified coronary artery lesions.
Contraindications: The OAS is contraindicated when the ViperWire Advance® Coronary Guide Wire cannot pass across the coronary lesion or the target lesion is within a bypass graft or stent. The OAS is contraindicated when the patient is not an appropriate candidate for bypass surgery, angioplasty, or atherectomy therapy, or has angiographic evidence of thrombus, or has only one open vessel, or has angiographic evidence of significant dissection at the treatment site and for women who are pregnant or children.
Warnings/Precautions: Performing treatment in excessively tortuous vessels or bifurcations may result in vessel damage; The OAS was only evaluated in severely calcified lesions, A temporary pacing lead may be necessary when treating lesions in the right coronary and circumflex arteries; On-site surgical back-up should be included as a clinical consideration; Use in patients with an ejection fraction (EF) of less than 25% has not been evaluated.
See the instructions for use before performing Diamondback 360 Coronary Orbital Atherectomy System procedures for detailed information regarding the procedure, indications, contraindications, warnings, precautions, and potential adverse events.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
Indications Statement: The Diamondback 360® Coronary Orbital Atherectomy System (OAS) is a percutaneous orbital atherectomy system indicated to facilitate stent delivery in patients with coronary artery disease (CAD) who are acceptable candidates for PTCA or stenting due to de novo, severely calcified coronary artery lesions.
Contraindications: The OAS is contraindicated when the ViperWire Advance® Coronary Guide Wire cannot pass across the coronary lesion or the target lesion is within a bypass graft or stent. The OAS is contraindicated when the patient is not an appropriate candidate for bypass surgery, angioplasty, or atherectomy therapy, or has angiographic evidence of thrombus, or has only one open vessel, or has angiographic evidence of significant dissection at the treatment site and for women who are pregnant or children.
Warnings/Precautions: Performing treatment in excessively tortuous vessels or bifurcations may result in vessel damage; The OAS was only evaluated in severely calcified lesions, A temporary pacing lead may be necessary when treating lesions in the right coronary and circumflex arteries; On-site surgical back-up should be included as a clinical consideration; Use in patients with an ejection fraction (EF) of less than 25% has not been evaluated.
See the instructions for use before performing Diamondback 360 Coronary Orbital Atherectomy System procedures for detailed information regarding the procedure, indications, contraindications, warnings, precautions, and potential adverse events.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
Results may vary.
Suggestions on case studies offered by the physician are based on their experience using the Diamondback® Orbital Atherectomy System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgment. CSI does not recommend or endorse any particular course of treatment or medical choice. Before using any medical device, including those demonstrated or referenced in this case study, review all relevant Instructions for Use, with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device.