Intravascular lithotripsy vs. rotational atherectomy on coronary microcirculation: a retrospective multicenter...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Biology

Background:

• Coronary microvascular dysfunction (CMD) is a significant predictor of adverse outcomes in patients with coronary artery disease (CAD).
• The impact of intravascular lithotripsy (IVL) on CMD is not well-established.
• Direct comparisons between IVL and rotational atherectomy (RA) regarding CMD are lacking.

Purpose of the Study:

• To evaluate and compare coronary microvascular dysfunction (CMD) using angiographic microvascular resistance (AMR) after percutaneous coronary intervention (PCI) assisted by IVL versus RA.
• To assess the incidence of CMD and peri-procedural adverse events (PPAEs) in patients undergoing IVL-assisted versus RA-assisted PCI for heavily calcified coronary lesions.

Main Methods:

• A multicenter retrospective cohort study involving propensity score-matched patients (1:2 ratio) who underwent either RA- or IVL-assisted PCI.
• Primary outcomes included post-PCI AMR values and CMD incidence.
• Secondary outcomes focused on peri-procedural adverse events (PPAEs).

Main Results:

• In the matched cohort (140 RA vs. 70 IVL), post-PCI AMR was significantly lower in the IVL group compared to the RA group (2.26 ± 0.50 vs. 2.43 ± 0.35, p=0.015).
• The incidence of CMD was comparable between the IVL and RA groups (27.1% vs. 32.9%, p=0.398).
• Peri-procedural adverse events (PPAEs) trended lower in the IVL group, although not statistically significant (17.1% vs. 27.9%, p=0.088).

Conclusions:

• Intravascular lithotripsy (IVL) is associated with less post-procedural coronary microvascular dysfunction compared to rotational atherectomy (RA), as evidenced by lower angiographic microvascular resistance (AMR).
• These findings suggest IVL may offer benefits in preserving coronary microvascular function.
• Further large-scale prospective studies are warranted to confirm these results and explore the clinical implications across diverse patient populations.