Laser, rotational, and orbital coronary atherectomy

Compared with non-calcified lesions, increased intracoronary calcium deposition leads to a higher incidence of major adverse cardiovascular events, particularly myocardial infarction. They are also associated with a higher frequency of restenosis, target lesion revascularization (TLR), vessel dissection during percutaneous coronary intervention (PCI), failure to deliver a stent, balloon ruptures, and undilatable lesions. Many of these challenges can be overcome by adequate lesion preparation. This chapter summarizes three atherectomy techniques (AT) that are employed as treatment strategies for calcific coronary lesions: rotational atherectomy (RA), orbital atherectomy (OA), excimer laser coronary atherectomy (ELCA). The business end of rotational atherectomy is a nickel-plated brass elliptical burr coated with diamond microchips on the front or crossing surface of the burr, with the rear half of the burr having no diamond chips and therefore no ablating surface. The ablative capabilities of ELCA are based on absorption of its energy in the atheroma, leading to photomechanical and photothermal processes.