Q&A
Q.
Did the Orbital Atherectomy (OA) seen during the live cases appear unimpressive?
A.
Agree that live OA cases were not impressive as we don’t use it in real tough calcified cases. Also our use of OA has gone further down after the negative Eclipse trial; of the 70 atherectomy cases per month at Sinai, OA cases are merely 1-5.
Q.
Is its claim of ease of use not matched by its effectiveness?
A.
Yes it’s correct that OA was introduced as a simpler atherectomy device then RA but its use has been limited due to higher acquisition cost and slightly higher coronary perforation.
Q.
Is there a lack of clarity regarding its use, resulting in areas of complete overlap that cause confusion?
A.
It is correct that both OA and RA can be exchanged in the majority of calcified lesions, with some preferences for RA or OA.
Q.
The delineation with IVL is less blurred?
A.
Agree fully that IVL is a supreme device and if can cross the calcified lesion, should be the default device due to it’s safety and efficacy (similar to RA). In some cases, 10-15% of cases, IVL will need adjunct device such as RA or OA for device synergy to get optimal results.
Q.
Could all three - Rotational Atherectomy, Orbital and IVL have been used for this case?
A.
Yes all 3 devices could have been used as the primary device in today’s case due to absence of tortuosity and lesions being <90% stenosed.
Q.
Should guidance be based on imaging?
A.
In my opinion, pre- procedure IVI is not essential for the individual device selection for calcium modification. If we are able to perform pre- procedure IVUS, then device choice may be selectively recommended; for Ca+ Nodule- RA or OA, for circular Ca+- IVL, for thin Ca+ ring- NC balloon or CB
Q.
Should imaging be mandatory?
A.
IVI is recommended but not mandatory in the treatment of calcified lesions. Post- procedure IVI will be very helpful in determining stent under expansion and edge dissections.
Q.
Is its benefit largely for post-PCI results?
A.
Yes real value of IVI in calcified lesions will be to improve the post PCI results by obtaining the highest possible MSA.
Q.
Where do you see the benefits of Terumo's dual imaging catheter?
A.
Terumo’s dual imaging catheter will have the best use in the calcified lesions by defining all the aspects of calcium including its thickness.
Q.
Will it genuinely help or cause confusion?
A.
It’s still long way to establish the exact role of dual imaging catheter using IVUS+OCT in PCI. I personally don’t think it will have much utility. In my opinion, better combination will be IVUS+FFR, OCT+FFR, OCT+NIRS etc.
