Trial Of Orbital Atherectomy Device In Calcified Coronary Arteries Completes Enrollment

In short

Cardiovascular Systems, Inc. has completed enrollment in its ORBIT II clinical trial, enrolling 443 patients. ORBIT II is evaluating the safety and effectiveness of the company’s orbital atherectomy technology in treating severely calcified coronary arteries.


It is estimated that moderate to severe arterial calcium is present in nearly 40 percent of those treated annually for coronary artery disease (CAD). ORBIT II is the first premarket approval (PMA) trial designed to study these difficult-to-treat patients.

CSI received FDA investigational device exemption (IDE) approval for the ORBIT II study in April 2010, and more than 45 U.S. medical centers enrolled patients. The primary endpoints of ORBIT II are based on a 30-day patient follow-up post procedure. Of the 443 patients enrolled in ORBIT II, 343 were treated with CSI’s original pneumatic orbital atherectomy system (OAS) and 100 with the company’s new electric OAS.

The company says its new electric coronary OAS offers a simpler design that gives physicians complete control of device operation, with minimal set up time.

CSI and the FDA agreed to a modular PMA submission. To date, modules 1 (preclinical) and 2 (manufacturing/system quality) have been submitted to the agency and are currently under review. The company’s PMA will be final on submission of module 3 which includes ORBIT II clinical data and proposed labeling. CSI anticipates that this will occur in early 2013.

CSI estimates that a coronary application would open up a large, underserved market opportunity for CSI, estimated to exceed $1.5 billion annually.

Company comments

“Completing ORBIT II enrollment is a significant milestone in our efforts to secure a coronary indication to treat arterial calcium—a vastly underestimated problem in medicine today,” said David L. Martin, CSI president and chief executive officer. “At TCT this year, Dr. Philippe Genereux presented new data proving, with statistical significance, that patients with moderate to severe calcium were more likely to die, and have major adverse coronary events–results Dr. Genereux described as ‘shocking.’”

Physician comments

Dr. Jeffrey Chambers, interventional cardiologist with Metropolitan Cardiovascular Consultants, Minneapolis, and Principal Investigator for the ORBIT II study, said, “Despite advanced stent technology, moderate to severe calcification remains a real challenge for interventional cardiologists, and new therapeutic approaches are needed. Based on promising results in treating severely calcified coronary arteries in the ORBIT I study, CSI’s orbital technology may be well suited for removing calcified plaque in coronary lesions. I look forward to seeing the results from ORBIT II and I’m hopeful that we will have a new therapy in the near future for these difficult-to-treat patients.”

Regulatory status

The U.S. FDA granted 510(k) clearance for the use of the Diamondback Orbital Atherectomy System in August 2007. To date, nearly 100,000 of CSI’s devices have been sold to leading institutions across the United States. CSI has also commenced its ORBIT II Investigational Device Exemption clinical trial to evaluate the safety and effectiveness of its orbital technology in treating coronary arteries. The coronary system is limited by federal law to investigational use and is currently not commercially available in the United States.

Source: Cardiovascular Systems, Inc.