Rotational Atherectomy With or Without Intravascular Lithotripsy for Patients With Heavy Coronary Artery...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology

Background:

• Heavy coronary artery calcification (CAC) presents challenges in percutaneous coronary intervention (PCI).
• Novel debulking technologies like intravascular lithotripsy (IVL) are emerging.
• Comparative data on combined rotational atherectomy (RA) and IVL is limited.

Purpose of the Study:

• To evaluate the additional effect of IVL after RA in patients with heavy CAC.
• To compare the safety and efficacy of RA + IVL versus RA alone in PCI.

Main Methods:

• Prospective enrollment of 1,365 patients with heavy CAC undergoing PCI with RA.
• Comparison of 150 patients treated with RA + IVL against 1,215 patients treated with RA alone.
• Assessment of serious angiographic complications and 30-day major adverse cardiovascular events (MACE).

Main Results:

• No significant difference in serious angiographic complications between RA + IVL and RA groups (3.3% vs. 4.6%, p=0.476).
• Propensity score analysis showed similar odds of complications (OR: 0.63; 95% CI: 0.24-1.63).
• Similar risk of 30-day MACE between the two groups (OR: 0.89; 95% CI: 0.30-2.64).

Conclusions:

• A PCI strategy combining RA followed by IVL demonstrates comparable short-term safety and efficacy to RA alone in heavy CAC.
• The addition of IVL to RA does not appear to increase adverse events in this patient population.
• This study provides valuable data on the combined use of RA and IVL for complex coronary interventions.