Complementary Utility of Intravascular Lithotripsy With Atherectomy for Severely Calcified Coronary Stenoses in...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology

Background:

• The effectiveness and safety of combining intravascular lithotripsy (IVL) with atherectomy for percutaneous coronary intervention (PCI) remain understudied.
• Novel IVL technology is increasingly used alongside conventional tools like atherectomy.

Purpose of the Study:

• To compare the effectiveness and safety of IVL with and without atherectomy in treating calcified de novo coronary lesions.
• To evaluate procedural outcomes and major adverse cardiovascular events (MACE) in patients undergoing PCI with IVL.

Main Methods:

• Retrospective analysis of 109 consecutive patients undergoing PCI with IVL from March 2021 to February 2022.
• Patients were divided into two groups: those treated with IVL plus atherectomy and those treated with IVL alone.
• Effectiveness (residual stenosis <30%) and safety (procedural complications, MACE) were compared between groups.

Main Results:

• Angiographic success was achieved in 85.7% of the combined group and 90.6% of the non-atherectomy group (P=.49).
• Coronary perforation occurred in one patient in each group (P=.52). Major dissection related to stent underexpansion occurred in 6.1% of the combined group versus 0% in the non-atherectomy group (P=.09).
• Thirty-day MACE occurred in 4.8% of patients, with higher mortality observed in the atherectomy group.

Conclusions:

• Combining IVL with atherectomy for calcified de novo lesions demonstrated similar procedural success and complication rates compared to IVL alone.
• Patients requiring the combined approach had higher risk features and mortality, underscoring the need for careful case selection and multidisciplinary management.
• The study suggests that while effective, the combined approach targets a sicker patient population, necessitating optimized care strategies beyond standard PCI.