Comparison of Orbital Versus Rotational Atherectomy Effects On Coronary Microcirculation in PCI

Exclusion Criteria

• •1. Estimated creatinine clearance \<30 ml/min using Cockcroft-Gault equation, unless the patient is on dialysis;
• •2. ST-elevation Myocardial Infarction (STEMI) within 24 hours of initial time of presentation to the first treating hospital, whether at a transfer facility or the study hospital.
• •3. PCI within 24 hours preceding the study procedure.
• •4. Cardiogenic shock (defined as persistent hypotension (systolic blood pressure \<90 mm/Hg for more than 30 minutes) or requiring pressors or hemodynamic support, including intra-aortic balloon pump (IABP), at time of procedure.
• •5. Mobitz II second degree or complete heart block
• •6. Malignant ventricular arrhythmias requiring treatment
• •7. Pulmonary edema defined as patient with shortness of breath, evidence of volume overload on physical exam, and crepitations on physical exam (\>1/3 of lungs) or radiographic interstitial or alveolar pulmonary edema
• •8. Subject is intubated.
• •9. Known left ventricular ejection fraction (LVEF) \<35%.
• •10. Severe valvular disease (e.g. severe mitral regurgitation or severe aortic stenosis)
• •11. Patient is participating in any other investigational drug or device clinical trial that has not reached its primary endpoint.
• •12. Women who are pregnant or breastfeeding (women of child-bearing potential must have a negative pregnancy test within one week before treatment).
• •General Inclusion - MRI Sub-Study
• •1. Patients with no prior MI/scarring in the subtended myocardial territory.
• •2. Patients with no contraindication for MRI studies
• •3. Patients who could safely receive Gadolinium (i.e. estimated glomerular filtration rate (eGFR) \>30)
• •1. Lesion length \<20mm
• •2. Study target lesion in a bypass graft
• •3. Ostial right coronary artery (RCA) study target lesion
• •4. Chronic total occlusion (Thrombolysis In Myocardial Infarction (TIMI) flow 0/1) study target lesion
• •5. Bifurcation study lesion with a planned dual stent strategy
• •6. In-stent restenosis study target lesion
• •General Inclusion - MRI Sub-Study
• •1. Patients with no prior myocardial infarction (MI)/scarring in the subtended myocardial territory.
• •2. Patients with no contraindication for Magnetic resonance imaging (MRI) studies
• •3. Patients who could safely receive Gadolinium (i.e. eGFR\>30)