Background

Severely calcified coronary artery lesions remain among the most challenging scenarios in percutaneous coronary intervention (PCI). Atherectomy devices facilitate plaque modification and improve stent delivery and expansion. Rotational atherectomy (RA) has historically served as the standard modality for calcium modification, whereas orbital atherectomy (OA) has emerged as a novel alternative with distinct mechanisms and procedural characteristics.

Objective

To compare orbital atherectomy and rotational atherectomy regarding procedural success, safety outcomes, lesion preparation efficacy, and long-term clinical outcomes in patients undergoing PCI for heavily calcified coronary lesions.

Methods

A multicenter retrospective-prospective comparative study was conducted involving 540 patients with severe coronary calcification undergoing PCI. Patients were divided into OA (n=260) and RA (n=280) groups. Procedural characteristics, angiographic outcomes, peri-procedural complications, and 12-month major adverse cardiovascular events (MACE) were analyzed.

Results

Procedural success was achieved in 96.5% of OA cases and 94.3% of RA cases (p=0.21). OA demonstrated significantly lower rates of slow-flow/no-reflow phenomena (3.8% vs. 8.2%, p=0.03) and coronary perforation (0.8% vs. 2.9%, p=0.04). Stent expansion measured by intravascular imaging was superior in the OA group (89.4% vs. 84.7%, p<0.01). Twelve-month MACE rates were lower in OA patients (10.2% vs. 14.8%, p=0.08), although the difference did not reach statistical significance.

Conclusion

Both OA and RA are effective plaque-modification techniques. OA may provide enhanced calcium modification, improved stent expansion, and fewer procedural complications. Future randomized studies are required to establish definitive superiority.