Intravascular lithotripsy with or without rotational atherectomy for coronary calcific nodule treatment

Calcific coronary nodules (CNs) are a challenging form of coronary artery disease, often linked to acute coronary syndromes (ACS) and resistant to standard lesion preparation. While intravascular lithotripsy (IVL) and rotational atherectomy (RA) are used for plaque modification, the optimal strategy remains unclear. This study compares procedural characteristics and mid-term outcomes of IVL alone versus IVL combined with RA (IVL + RA) in patients with CNs.

In this prospective, single-center study, 120 patients with angiographically confirmed CNs undergoing PCI were analyzed after 1:1 propensity score matching (PSM) to compare IVL (n = 60) versus IVL + RA (n = 60). Clinical, angiographic, and procedural data were collected. The primary endpoint was major adverse cardiovascular events (MACE) at 6 months, including cardiovascular death, ACS, or target vessel revascularization. Secondary endpoints included intraprocedural complications and 30-day outcomes.

Baseline characteristics and lesion complexity were well matched between groups. Procedural success and stent deployment metrics were similar. Rates of intraprocedural complications were low and not significantly different (6.7 % IVL vs. 8.3 % IVL + RA; p = 0.68). At 6 months, MACE rates were comparable (8.3 % vs. 10.3 %; p = 0.68), with no differences in cardiovascular death (5.0 % vs. 6.9 %) or ACS (6.7 % vs. 8.6 %).

In patients with calcific nodules, both IVL alone and the IVL + RA combination showed similar safety and efficacy, with low complication rates and comparable mid-term outcomes. Further randomized studies are needed to determine the optimal treatment approach for this high-risk group.