The Use of Imaging to Guide Treatment Decisions with Coronary Orbital Atherectomy – Case 2 of 2
Dr. Brock Cookman describes this real-world case to demonstrate the importance of imaging to determine strategy and treatment in complex scenarios and how the unique dual-action mechanism of action (MOA) of the Diamondback 360® Coronary Orbital Atherectomy System sands superficial and fractures deep calcium.
A 78-year-old female patient presented with increasing dyspnea on exertion. She was found to have severe mitral stenosis and acute kidney injury which delayed her cardiac catheterization. Unfortunately, prior to diagnostic cardiac catheterization, she had an acute neurological event and was diagnosed with a posterior circulation ischemic stroke. She ultimately underwent diagnostic catheterization and was found to have calcified stenosis of the LAD.
Initial intravascular imaging was attempted with an OCT catheter; however, it would not pass through the calcified mid LAD lesion. Due to presence of calcium noted on angiography and the inability to pass an imaging catheter, orbital atherectomy was performed of the LAD.
Post-orbital atherectomy, intravascular imaging was performed with OCT. This revealed calcified nodular disruption in the mid LAD. The eccentric calcified nodule was appropriately modified in this case by the unique orbital action of the crown.
Post-stent deployment, due to appropriate plaque modification, stent delivery was not an issue and excellent stent expansion was observed.
- Coronary calcification is an increasing problem in patients undergoing Percutaneous Coronary Intervention (PCI) procedures.
- The Diamondback 360® Coronary Orbital Atherectomy System has a unique dual-action mechanism of action (MOA) that sands superficial and fractures deep calcium, which has been demonstrated through imaging.
- Plaque modification was necessary in order to deliver a stent and/or devices across a calcified lesion. Due to the dual-action MOA of the Diamondback 360 device, appropriate plaque modification was able to be performed, leading to ease of stent/device delivery and better stent expansion – which has been shown to improve long-term results.
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