Comparative Analysis of Intravascular Lithotripsy With and Without Atherectomy in Severely Calcified Coronary Lesions Using OCT and OFDI

Background Intravascular lithotripsy (IVL) fractures calcified plaques and facilitates lesion expansion; however, unlike atherectomy devices, it does not reduce calcium volume. The therapeutic efficacy and safety of combining IVL with atherectomy remain unclear. Therefore, this study aimed to evaluate, through optical coherence tomography (OCT) or optical frequency domain imaging (OFDI), whether IVL combined with atherectomy provides greater effectiveness compared with IVL alone. Aims This study aimed to evaluate, using optical coherence tomography (OCT) and optical frequency domain imaging (OFDI), whether intravascular lithotripsy (IVL) combined with atherectomy provides greater procedural efficacy and safety compared with IVL alone in the treatment of severely calcified coronary lesions. Methods A retrospective analysis was performed on 33 lesions in 31 patients who underwent IVL‐based percutaneous coronary intervention (PCI) with OCT or OFDI. The primary endpoints were post‐PCI minimal lumen diameter (MLD) and minimal lumen area (MLA). The secondary endpoints included calcium fracture thickness, lesion expansion rate, and vessel expansion index. Results The mean patient age was 72.3 ± 8.5 years, and 80.6% were men. No significant differences were identified in post‐PCI MLD or MLA between the IVL alone and IVL + atherectomy groups (MLD: 2.46 ± 0.38 vs. 2.23 ± 0.56 mm; MLA: 4.9 ± 1.55 vs. 4.19 ± 1.90 mm 2 ). The secondary endpoints were also comparable. However, the combination group demonstrated a longer procedural time (82.7 ± 19.6 vs. 109.8 ± 34.0 min) and a higher incidence of periprocedural myocardial infarction (0 vs. 3 patients). Conclusions Combination therapy resulted in a longer procedural time and an increased incidence of myocardial injury. IVL alone may be sufficient in lesions where device delivery is feasible, whereas atherectomy should be performed when IVL delivery is challenging.