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A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
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Intravascular lithotripsy versus rotational atherectomy for coronary atherosclerosis calcification: a systematic

Pirel Aulia Baravia1, Faqrizal Ria Qhabibi2, Isman Firdaus3

  • 1University of Brawijaya, Malang, Indonesia. pirelaulia@gmail.com.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|May 21, 2026
PubMed

Insights

Intravascular lithotripsy (IVL) shows similar procedural outcomes to rotational atherectomy (RA) but offers lower short-term mortality and major adverse cardiac events. Long-term data suggests comparable MACE rates between IVL and RA.

Area of Science:

  • Cardiovascular Interventions
  • Medical Device Technology
  • Interventional Cardiology

Background:

  • Intravascular lithotripsy (IVL) is an emerging strategy for modifying coronary artery calcification (CAC).
  • Limited comparative evidence exists for IVL efficacy versus rotational atherectomy (RA).

Purpose of the Study:

  • To compare the efficacy and safety of IVL versus RA in patients with moderate-to-severe CAC.
  • Evaluate outcomes including major adverse cardiac events (MACE), mortality, and procedural success.

Main Methods:

  • Systematic search of observational studies and randomized controlled trials (RCTs) up to March 2025.
  • Meta-analysis of 968 patients (418 IVL, 550 RA) using Mantel-Haenszel risk ratios and inverse variance mean differences.
  • Primary endpoint: MACE; Secondary endpoints: mortality, complications, procedural outcomes.

Main Results:

  • IVL demonstrated lower in-hospital MACE (1.5% vs. 5.3%) and all-cause mortality (1.6% vs. 5.4%) compared to RA.
  • Longer-term follow-up showed comparable MACE rates (4.3% vs. 7.7%) but continued lower all-cause mortality with IVL (2.5% vs. 7.0%).
  • No significant differences in myocardial infarction, dissection, perforation, or slow/no-reflow; procedural success and efficiency were similar.

Conclusions:

  • IVL and RA exhibit comparable procedural outcomes and periprocedural complication rates.
  • IVL is associated with reduced short-term all-cause mortality and MACE.
  • While long-term MACE rates appear similar, IVL maintains an advantage in reducing all-cause mortality.
Abstract

Keywords:
Coronary artery calcificationIntravascular lithotripsyPercutaneous coronary interventionRotational atherectomy

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