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  • Intracoronary Imaging Evaluation of Pull-Back Orbital Atherectomy in Tortuous Coronary Artery With Nodular Calcified Lesion

    A 66-year-old man with stable angina had a significant calcified stenosis in the mid-left anterior descending coronary artery with severe tortuosity as an indication of revascularization ( Fig. 1 A, B). A 60-MHz high-resolution intravascular ultrasound imaging (IVUS) (Terumo, Tokyo, Japan) was used to pass the lesion to a small degree. An eccentric and large nodular calcified lesion (NCL) was detected with minimum rumen area (MLA) of 2.8 mm 2 . ( Fig. 1 D). Next, an orbital atherectomy system (OAS) (Diamondback 360 Coronary Classic, CSI, St. Paul, MN, USA) was utilized for lesion modification. The OAS was able to pass the lesion using the glide-assist mode without any prior balloon dilatation. In the low-speed mode, the OAS was slowly pulled back using guide wire bias more than 10 times ( Video 1 ). The intravascular ultrasound revealed sufficient ablation at the central part of the vessel with enlarged MLA (4.2 mm 2 ) and reverberation ( Fig. 1 E, Video 2 ). Following dilatation with a cutting balloon (Wolverine 2.75 ∗ 10 mm, Boston Scientific, Marlborough, MA, USA), a drug-eluting stent (Synergy XD 2.5 ∗ 24 mm, Boston Scientific) was sufficiently expanded after post-dilatation with 3.0-mm balloon resulting in a minimum stent area of 5.0 mm 2 ( Fig. 1 C, F). There were no complications related to OAS, such as vessel perforation, severe dissection, coronary slow flow, and bradycardia.

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