Comparison of intravascular lithotripsy and rotational atherectomy for the treatment of heavily calcified coronary...

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Percutaneous coronary interventions (PCI) for heavily calcified lesions present significant technical challenges and are linked to poorer prognoses.
• Effective lesion preparation is crucial for minimizing complications and enhancing outcomes in PCI procedures.
• Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are key techniques for preparing calcified coronary arteries.

Purpose of the Study:

• To compare the efficacy of rotational atherectomy (RA) versus intravascular lithotripsy (IVL) in achieving optimal stent implantation.
• To evaluate stent implantation success using intravascular ultrasound (IVUS) criteria in heavily calcified coronary lesions.

Main Methods:

• A retrospective, single-center study involving patients who underwent PCI for heavily calcified coronary lesions.
• Comparison of outcomes between patients treated with RA and those treated with IVL.
• Assessment of stent implantation success based on pre-established intravascular ultrasound criteria.

Main Results:

• The intravascular lithotripsy (IVL) group achieved a significantly larger final minimal lumen area (7.6 mm² vs. 5.4 mm²; P=0.01) and lumen area gain (4.1 mm² vs. 2.3 mm²; P=0.01).
• 100% of patients in the IVL group met the criteria for successful stent implantation, compared to 69.2% in the rotational atherectomy (RA) group (P=0.04).
• The final stent volume was also significantly larger in the IVL group (491.2 mm³ vs. 326.2 mm³; P=0.03).

Conclusions:

• Intravascular lithotripsy (IVL) facilitates a higher rate of successful stent implantation in heavily calcified coronary lesions compared to rotational atherectomy (RA).
• IVL treatment resulted in superior angiographic outcomes, including larger lumen dimensions post-intervention.
• These findings suggest IVL is a more effective modality for lesion preparation in complex PCI cases.