Rotational Atherectomy Versus Intravascular Lithotripsy for Calcified In-Stent Restenosis: A Single-Center Study With...

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Calcified de novo coronary lesions are effectively treated with rotational atherectomy (RA) and intravascular lithotripsy (IVL).
• The application of RA and IVL for in-stent restenosis (ISR) remains controversial, with limited comparative data.
• No previous studies have directly compared RA and IVL in patients with calcified ISR.

Purpose of the Study:

• To evaluate the safety and feasibility of RA and IVL in patients with calcified ISR.
• To compare in-hospital and 1-year clinical outcomes between RA and IVL for calcified ISR.

Main Methods:

• Retrospective, single-center study comparing patients with calcified ISR treated with RA (2012-2021) and IVL (2019-2021).
• 28 patients undergoing RA were compared with 24 patients undergoing IVL.
• Procedural success, quantitative coronary analysis (stenosis degree, luminal gain), and clinical outcomes (major adverse cardiovascular events, target vessel revascularization) at in-hospital and 1-year follow-up were assessed.

Main Results:

• 100% procedural success rate for both RA and IVL groups.
• No significant differences in pre-procedure or post-procedure stenosis, or acute luminal gain between RA and IVL.
• Similar rates of in-hospital major adverse cardiovascular events (1 event in RA group) and 1-year rates of major adverse cardiovascular events (14.3% vs 16.7%) and target vessel revascularization (7.1% vs 12.5%) between the groups.

Conclusions:

• Rotational atherectomy and intravascular lithotripsy are safe and feasible treatment options for calcified in-stent restenosis.
• Both techniques demonstrate comparable procedural success and clinical outcomes at 1-year follow-up.
• Further clinical studies are needed to confirm these findings and identify optimal patient and lesion characteristics for each approach.