Related Experiment Video
Updated: Oct 13, 2025
A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
Published on: September 13, 2022
Comparative study of costs and resource utilization of rotational atherectomy versus intravascular lithotripsy for
Shafeer Rishad1,2, Margaret McEntegart2, Thomas J Ford2,3
1University of Glasgow, Glasgow, UK.
Insights
Intravascular lithotripsy (IVL) offers lower costs and resource use compared to rotational atherectomy (RA) for heavily calcified coronary lesions. Despite higher initial device costs, IVL reduces overall expenses and material consumption during percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Health Economics
Background:
- Intravascular lithotripsy (IVL) is an emerging alternative to rotational atherectomy (RA) for treating severely calcified coronary arteries.
- Percutaneous coronary intervention (PCI) often requires lesion modification in such cases.
Purpose of the Study:
- To compare the real-world resource utilization and associated costs of PCI with adjunctive IVL versus RA.
- To evaluate the economic and procedural differences between IVL and RA in clinical practice.
Main Methods:
- An indirect comparison was made between 120 patients undergoing PCI with IVL (Disrupt-CAD II study) and 60 patients undergoing PCI with RA.
- Patients receiving RA were selected consecutively and deemed suitable for IVL by an independent cardiologist.
- Resource utilization, in-lab consumable costs, and procedural data were analyzed.
Main Results:
- PCI with IVL demonstrated significantly lower overall costs compared to PCI with RA (mean difference £398).
- The IVL group used fewer procedural materials, including balloons, guidewires, guide catheters, guide extensions, and drug-eluting stents (DES).
- IVL was associated with shorter procedural duration but longer fluoroscopy times.
Conclusions:
- The higher initial device cost of IVL may be compensated by reduced overall resource utilization.
- Further research, including randomized trials with formal health economic analysis, is needed to confirm these findings.
- IVL presents a potentially cost-effective option for modifying calcified coronary lesions.
Background:
Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) for the modification of heavily calcified coronary stenoses prior to percutaneous coronary intervention (PCI). We compare the real-world resource utilization and associated costs of PCI with adjunctive RA and IVL.
Methods:
We compared the resource utilization, in-lab consumable costs and procedural data of 120 patients who underwent PCI with IVL from the Disrupt-CAD II study (NCT03328949) to 60 patients who underwent PCI with RA at the Golden Jubilee National Hospital, Glasgow, UK. The RA patients were consecutive and selected on the basis of being deemed suitable for IVL by an independent interventional cardiologist experienced in the use of both techniques.
Results:
PCI with IVL was associated with significantly lower costs than PCI with RA (mean difference £ 398 [95% CI: £ 181-615]; P<0.001). Considering between-group differences, the IVL group used 4.02 fewer balloons (P<0.001), 3.03 fewer guidewires (P<0.001), 0.52 fewer guide catheters (P=0.001), 0.22 fewer guide extensions (P=0.004) and 1.03 fewer drug eluting stents (DES) (P<0.001) per case than the RA group. The IVL group had shorter procedural duration (mean difference 13.3 min [95% CI: 3.6-23.0]; P=0.008) but longer fluoroscopy times (mean difference 4.4 min [95% CI: 1.7-7.1]; P=0.002).
Conclusions:
In this indirect comparison, we found that the higher initial device costs of IVL may be offset by a lower overall resource utilization. Further research is required to confirm this, and future randomized trials should include a formal health economic analysis.
More Related Videos
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
05:31Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
Published on: September 20, 2020
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:25Urinary Tract Calculi VI: Surgical Management
01:28Cardiac Catheterization I: Pre-Procedure Overview