'RotaShock' - A Revolution in Calcium Modification: Long-term Follow-up from a Single High-volume Centre

Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are well-established technologies for modification of coronary calcification. Given their contrasting mechanisms of action, there has been interest in whether the use of these devices in conjunction could potentially be synergistic and offer improved procedural results. The aim of this study was therefore to evaluate the efficacy, procedural safety and long-term outcomes of combining RA and IVL, termed 'RotaShock' (RSK), for the treatment of severe coronary calcification.

A single- centre retrospective analysis was carried out of consecutive patients treated with an RSK strategy for coronary calcification from January 2019 until September 2022. Baseline demographics, comorbidity details, details of the percutaneous coronary intervention procedure, angiographic and/or intracoronary imaging (ICI) results and presence of target vessel revascularisation or mortality were recorded.

A total of 36 patients were treated with RSK; the majority of patients were male (n=29; 80.6%) and the median age was 75 years (IQR 70-79 years). The majority of cases involved treating the left anterior descending artery (63.4%) but one-third involved percutaneous coronary intervention to the left main coronary artery. The vast majority of cases were guided by ICI (88.9%) and were performed through radial access (80.6%). In patients with ICI available for analysis, the median minimum stent area was 7.7 mm² (IQR 6.2-10.0 mm²). There were two access site complications but no other periprocedural complications. The median follow-up was 942 days (IQR 645-1,306 days). Despite the high complexity of lesions treated, follow-up identified only two cases of target vessel revascularisation. There were five cases of non-adjudicated all-cause mortality.

RSK is an effective and safe strategy for modification of severe coronary calcification, with long-term results suggesting a highly durable result. Further and randomised data are now mandated to evaluate the relative merits of RSK compared with RA or IVL alone.