Dr. Sengottuvelu G, leading interventional cardiologist of India performed two cases of novel orbital
atherectomy procedures last week. Orbital Atherectomy was introduced in India and these two
procedures were among the first few cases in India.
Dr. Sengottuvelu G, senior interventional cardiologist, Apollo main hospitals, Chennai and his team
performed two cases using orbital atherectomy in patients having heavily calcified coronary arteries.
One patient among them was an elderly patient post bypass surgery 15 years ago having chest pain at
rest and had severely calcified tortuous left anterior descending artery. Patient was at high risk for redo
coronary artery bypass surgery and anatomy of his vessels was unsuitable for bypass surgery. He
underwent successful ablation of calcium using Diamond Back orbital atherectomy device with slow and
at high speeds.
Calcified lesions are difficult, challenging subsets to treat as they are hard and conventional balloon
angioplasty do not work. There are several tools available to treat these hard blocks such as rotational
atherectomy, intravascular lithotripsy, specialised balloons etc. Rotational atherectomy was only option
available for several years. Shock wave intravascular lithotripsy was introduced few years ago and is
based on ultrasound waves delivered with a balloon.
Orbital atherectomy is a novel therapy used for opening up calcified blocks ( plaques) before stenting. It
has a 1.25 mm diamond-coated crown which ablates the calcium into fine particles approximately 2
micron in size ( sanding) and creates micro fractures in the calcium. The crown rotates in a circular
motion within the vessel and it acts both during forward and backward movement. Device can be
operated at low and high speeds and is decided based on the anatomy of the patient.
The availability of this device adds another option to treat these calcified blocks. It is particularly helpful
in large vessels with long calcified eccentric lesions. The device has a learning curve and operator needs
to be trained.
The team has successfully done several innovative precision stenting techniques in complex lesions
with good results.