Q&A
Q.
Overall, how much is Orbital Atherectomy (OA) use at Mt. Sinai?
A.
At MSH we use atherectomy in about 22% of 320-340 PCI cases per month (n= 70 cases).
Of this RA in 70%, OA in 28% and ELCA in 2% of cases.
Q.
And of Rotational Atherectomy (RA)?
A.
At MSH we use atherectomy in about 22% of 320-340 PCI cases per month (n= 70 cases).
Of this RA in 70%, OA in 28% and ELCA in 2% of cases.
Q.
How much will this change in 3 years?
A.
I expect atherectomy volume and % at MSH will continue to rise in next 3 years, because of selective referral of these calcified complex cases/pts from other interventionalists.
Q.
What factors are contributing to this change?
A.
A large number of interventionalists, do not want to learn or do atherectomy and hence will refer them to ‘Atherectomy center of Excellence’ like MSH. It is good for all; doctors, pts and MSH by providing the best and safest treatment in the complex anatomy.
Q.
What are the top three technical tips about OA that you would like to share?
A.
Top three technical tips for OA are; slow advancement (1mm/sec), slow speed (80k rpm only) and 3-5 times ablation across the lesion due to differential vertical motion of the OA crown.
Q.
Can you explain about crown size and sizing?
A.
We have only one OA crown size (1.25mm) which can give post procedure MLD of 1.6-1.7mm at 80K speed and up to 1.9mm MLD with 120k speed. Another device called Micro-crown (additional ablative surface at the tip) will not be released in USA.
Q.
And the dedicated wire?
A.
OA is a very effective device and 80k speed is sufficient even in large vessels and is associated with less complications (especially perforations).
Q.
How do you beneficially use the speed of OA?
A.
OA is a very effective device and 80k speed is sufficient even in large vessels and is associated with less complications (especially perforations).
Q.
What has been your worst complication with OA?
A.
Large coronary perforation causing hemodynamic collapse is the worst complication of OA.
Q.
Which seems better for severe calcification - of course, we saw your algorithm. RA or OA?
A.
Concentric severe calcification of >270 degree arc is ideal for OA and others are good for RA.
One Response
Excellent