Citation: Cardiovascular Revascularization Medicine. 2019 Mar 21.Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: ; 2019ISSN: 1878-0938.Full author list: Shlofmitz E; Martinsen BJ; Behrens AN; Ali ZA; Lee MS; Puma JA; Shlofmitz RA; Chambers JW.UI/PMID: 30982659.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1016/j.carrev.2019.03.011 (Click here)Abbreviated citation: Cardiovasc Revasc Med. 2019 Mar 21.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: BACKGROUND: Direct stenting offers many potential advantages in appropriately selected lesions. Coronary artery calcification increases the complexity and risk of adverse events associated with percutaneous coronary intervention. This study aimed to examine the feasibility of direct stenting after treatment with orbital atherectomy (OA).Abstract: METHODS: ORBIT II was a single-arm trial enrolling 443 subjects with de novo severely calcified coronary lesions treated with OA; direct stenting was utilized in 59.0% of cases. Procedural outcomes and 3-year major adverse cardiac event (MACE) rates were compared in subjects treated with pre-stent balloon dilatation versus direct stenting after OA.Abstract: RESULTS: Procedural success (84.2% vs. 93.3%; p=0.004) was significantly higher in the direct stenting cohort. 3-year MACE occurred less frequently in the direct stenting cohort (29.9% vs. 19.1%; p=0.006), driven by lower rates of myocardial infarction and target lesion revascularization. In a propensity matched analysis, procedural success and 3-year MACE rates were similar in the pre-stent balloon dilatation and direct stenting groups (85.0% vs. 91.8%; p=0.122 and 28.2% vs. 19.6%; p=0.078, respectively).Abstract: CONCLUSIONS: Orbital atherectomy facilitates direct stenting and is associated with high procedural success and favorable 3-year outcomes in carefully selected patients. Randomized studies are needed to assess the optimal strategy after lesion preparation with OA.Abstract: Copyright (c) 2019 Elsevier Inc. All rights reserved.