Conflict of interest: The authors acknowledge the following financial interests in products/companies relevant to submitted manuscript: Consultancies with Cardiovascular Systems Inc. (St. Paul, MN): Tony Das, M.D., George Adams, M.D., Jihad Mustapha, M.D., Jeffrey Indes, M.D., Robert Vorhies, M.D., and Nilesh Doshi, M.D. No relevant financial interest: Robert Beasley, M.D.
Peripheral Vascular Disease
Technique optimization of orbital atherectomy in calcified peripheral lesions of the lower extremities
The CONFIRM series, a prospective multicenter registry
Article first published online: 7 OCT 2013
Copyright © 2013 The Authors. Wiley Periodicals, Inc.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Catheterization and Cardiovascular Interventions
Volume 83, Issue 1, pages 115–122, 1 January 2014
How to Cite
Das, T., Mustapha, J., Indes, J., Vorhies, R., Beasley, R., Doshi, N. and Adams, G. L. (2014), Technique optimization of orbital atherectomy in calcified peripheral lesions of the lower extremities. Cathet. Cardiovasc. Intervent., 83: 115–122. doi: 10.1002/ccd.25046
- Issue published online: 18 DEC 2013
- Article first published online: 7 OCT 2013
- Accepted manuscript online: 4 JUN 2013 07:50AM EST
- Manuscript Accepted: 22 MAY 2013
- Manuscript Received: 26 APR 2013
- Cardiovascular Systems Inc., St. Paul, MN
- peripheral arterial disease;
- endovascular intervention;
- limb ischemia;
- vascular calcification;
- plaque morphology;
- clinical study
The purpose of CONFIRM registry series was to evaluate the use of orbital atherectomy (OA) in peripheral lesions of the lower extremities, as well as optimize the technique of OA.
Methods of treating calcified arteries (historically a strong predictor of treatment failure) have improved significantly over the past decade and now include minimally invasive endovascular treatments, such as OA with unique versatility in modifying calcific lesions above and below-the-knee.
Patients (3135) undergoing OA by more than 350 physicians at over 200 US institutions were enrolled on an “all-comers” basis, resulting in registries that provided site-reported patient demographics, ABI, Rutherford classification, co-morbidities, lesion characteristics, plaque morphology, device usage parameters, and procedural outcomes.
Treatment with OA reduced pre-procedural stenosis from an average of 88–35%. Final residual stenosis after adjunctive treatments, typically low-pressure percutaneous transluminal angioplasty (PTA), averaged 10%. Plaque removal was most effective for severely calcified lesions and least effective for soft plaque. Shorter spin times and smaller crown sizes significantly lowered procedural complications which included slow flow (4.4%), embolism (2.2%), and spasm (6.3%), emphasizing the importance of treatment regimens that focus on plaque modification over maximizing luminal gain.
The OA technique optimization, which resulted in a change of device usage across the CONFIRM registry series, corresponded to a lower incidence of adverse events irrespective of calcium burden or co-morbidities. © 2013 The Authors. Wiley Periodicals, Inc.