Coronary Artery Disease (CAD) Clinical Trial
Official title:
Comparison of Orbital Versus Rotational Atherectomy Effects On Coronary Microcirculation in Percutaneous Coronary Intervention (PCI)
The investigators hypothesize that the orbital atherectomy system (OAS), a newer generation atherectomy device, reduces the incidence of microcirculatory compromise as compared to older generation rotational atherectomy (RA) due to differences in the mechanism of athero-ablation.
The presence of heavily calcified coronary lesions necessitates the use of ablative devices
that aid in successful percutaneous coronary intervention (PCI). However, atherectomy devices
generate microparticles that embolize to the distal coronary microcirculation and may
compromise myocardial tissue perfusion.
Two mechanisms that deserve particular attention are the eccentric mounting of the OAS crown
and the higher flow rates on the vasodilator flush. Firstly, as opposed to rotational
atherectomy where the larger, centrally mounted burr may cause obstruction of flow during the
atherectomy, the smaller eccentrically mounted crown in OAS allows continuous perfusion
during both atherectomy as well as rest periods. Second, both during rest and atherectomy,
the flow rates of vasodilatory flush is higher in OAS compared to RA. Combined, these
differences in coronary and vasodilator flush flow could lead to improved perfusion of the
distal circulation, particularly during the atherectomy runs when risk of embolization is
highest.
The loss of microcirculatory function can be transient, with partial or complete restoration
of microcirculatory blood flow, or permanent. As shown in studies of patients with acute
coronary syndromes, the loss of microcirculatory function is a critical and independent
predictor of myocardial recovery and adverse outcomes. The putative protective effects of OAS
on coronary microvasculature may therefore be of major clinical significance and impact.
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