What question did this study set out to answer?

The research aims to compare the long-term clinical outcomes of intravascular lithotripsy and atherectomy in patients with coronary artery disease.

March 18, 2026Open Access

Intravascular Lithotripsy Is Associated With Superior Clinical Outcomes Compared to Atherectomy: A Large‐Scale, Propensity‐Matched Analysis

Key Result

Intravascular lithotripsy was associated with lower 1-year risks of mortality (RR 0.64), myocardial infarction (RR 0.80), and MACE (RR 0.71) compared to atherectomy in coronary artery disease.

Key Points

The research aims to compare the long-term clinical outcomes of intravascular lithotripsy and atherectomy in patients with coronary artery disease.
Conducted a retrospective cohort study using data from the TriNetX Research Network.
Analyzed clinical outcomes in patients undergoing PCI with DES using either IVL or ATH.
Performed propensity matching to create comparable cohorts for analysis.
IVL demonstrated a 36% lower risk of all-cause mortality at 1 year compared to ATH.
IVL associated with lower rates of myocardial infarction (20% reduction) and major adverse cardiovascular events (29% reduction).
30-day complications were less frequent with IVL, showing a 23% reduction overall, including a 56% reduction in bleeding.

Structured PICO

Does intravascular lithotripsy improve 1-year clinical outcomes and reduce 30-day procedural complications compared to atherectomy in adults with CAD undergoing single-vessel PCI?

Population

Adults with coronary artery disease (CAD) undergoing single-vessel percutaneous coronary intervention (PCI) with drug-eluting stent (DES)

Intervention

Intravascular lithotripsy (IVL)

Comparator

Atherectomy (ATH)

Outcome

1-year clinical outcomes (all-cause mortality, myocardial infarction, MACE) and 30-day procedural complicationshard clinical

In a large, real-world propensity-matched analysis, intravascular lithotripsy was associated with significantly lower 1-year mortality, MI, and MACE, as well as fewer 30-day procedural complications compared to atherectomy for complex coronary lesions.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Background Coronary artery disease (CAD) with severe calcification remains a growing challenge in percutaneous coronary intervention (PCI). Atherectomy (ATH) has long been used for plaque modification, whereas intravascular lithotripsy (IVL) has emerged as a promising alternative. Large‐scale comparative data on long‐term outcomes are limited. Aims To compare 1‐year clinical outcomes, 30‐day procedural complications, and temporal trends between IVL and ATH use. Methods We conducted a retrospective cohort study using the TriNetX Research Network, analyzing de‐identified data from 47 health care organizations. Adults with CAD undergoing single‐vessel PCI with drug‐eluting stent (DES) and either IVL or ATH were included. Outcomes were assessed after propensity matching, and annual utilization trends were evaluated from 2013 to 2024. Results We identified 13,499 patients who underwent DES with IVL ( n = 7026) or ATH ( n = 6473). After matching, 5768 patients remained in each cohort. At 1 year, IVL was associated with lower risk of all‐cause mortality (RR 0.64; 95% CI 0.58−0.72; p < 0.0001), myocardial infarction (RR 0.80; 95% CI 0.66−0.96; p = 0.0166), and MACE (RR 0.71; 95% CI 0.62−0.82; p < 0.0001). IVL also reduced 30‐day procedural complications (RR 0.77; 95% CI 0.61−0.97; p = 0.0271), with less bleeding (RR 0.44; 95% CI 0.31−0.62; p < 0.0001) and CA‐AKI (RR 0.71; 95% CI 0.55−0.91; p = 0.0068). IVL use increased rapidly and surpassed ATH after 2022. Conclusion In this large, real‐world registry, IVL was associated with more favorable 1‐year outcomes and fewer 30‐day complications than ATH. These findings support IVL as a safe and effective alternative for complex coronary lesions, emphasizing the need for validation in randomized trials to assess for causality.