{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:13:56Z","timestamp":1788351236870,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":244,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Severe coronary artery calcification (CAC) can complicate percutaneous coronary intervention (PCI) and is associated with less favourable procedural and clinical outcomes. Rotational atherectomy (RA) and orbital atherectomy (OA) are established calcium\u2010modification strategies used to facilitate PCI in heavily calcified lesions. This systematic review and meta\u2010analysis evaluated the comparative clinical and procedural outcomes of RA and OA in patients with severe CAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis was conducted in accordance with PRISMA 2020 guidance. PubMed, EMBASE, and CENTRAL were searched from inception to July 2026 for studies directly comparing RA and OA in patients undergoing PCI for severe CAC. Eligible studies were synthesised quantitatively where appropriate and narratively otherwise. Risk of bias was evaluated using the Newcastle\u2013Ottawa Scale for observational studies and the Cochrane Risk of Bias 2 tool for the randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No statistically significant differences between RA and OA were identified for short\u2010term major adverse cardiovascular events (MACE), short\u2010 or long\u2010term all\u2010cause mortality, cardiac mortality, long\u2010term nonfatal myocardial infarction (MI) or short\u2010term target vessel revascularisation (TVR). Compared with OA, RA was associated with higher odds of long\u2010term MACE (OR 1.51, 95% CI 1.01\u20132.26), short\u2010term nonfatal MI (OR 1.77, 95% CI 1.05\u20132.98) and long\u2010term TVR (OR 2.51, 95% CI 1.12\u20135.64). Conversely, coronary dissection occurred less frequently with RA (OR 0.38, 95% CI 0.20\u20130.72). There were no significant between\u2010group differences in cardiac tamponade, device\u2010induced coronary perforation, slow\u2010flow\/no\u2010reflow, fluoroscopy time or contrast volume.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this updated meta\u2010analysis of more than 80,000 patients, OA was associated with lower pooled rates of long\u2010term MACE, short\u2010term nonfatal MI and long\u2010term TVR, whereas RA was associated with a lower rate of coronary dissection. No consistent difference in all\u2010cause mortality was demonstrated. Given the predominantly observational evidence base, these associations should not be interpreted as evidence of causal superiority, and device selection should remain individualised according to lesion characteristics, intravascular imaging findings and operator expertise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cdr\/4716803","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:22:56Z","timestamp":1788348176000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Outcomes of Rotational Versus Orbital Atherectomy in Calcified Coronary Lesions: An Updated Systematic Review and Meta\u2010Analysis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-9824","authenticated-orcid":false,"given":"Eyad","family":"Jamileh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8257-1260","authenticated-orcid":false,"given":"Ahmed","family":"Elmewafy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5554-5293","authenticated-orcid":false,"given":"Fahad","family":"Muhammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5814-0061","authenticated-orcid":false,"given":"Ahmed Ali","family":"Kayyale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama Al Bushe","family":"Ade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelmadjid","family":"Zinet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umar Faruq","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4374-7476","authenticated-orcid":false,"given":"Ibrahim","family":"Antoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.10.065"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.01.017"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(90)90282-T"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.007448"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.01.158"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.24700"},{"key":"e_1_2_12_7_2","first-page":"1242","article-title":"Rotational Versus Orbital Atherectomy for Treating Heavily Calcified Coronary Lesions: A Meta-Analysis","volume":"96","author":"Khan M. 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Comparing rotational and orbital atherectomy for the treatment of calcified coronary lesions: An updated systematic review and meta-analysis (PROSPERO Record No. CRD420251113632) https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD420251113632."},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40119-021-00214-w"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-024-01055-w"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.5114\/aic.2023.125993"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.28886"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.37532\/fmic.2020.12(2).647"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-17-01060"},{"key":"e_1_2_12_19_2","first-page":"E65","article-title":"Coronary Orbital Atherectomy: Device Success and Safety in Calcified Coronary Lesions: Results From the ORBIT II Trial","volume":"30","author":"Chambers J. 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