Rotational atherectomy vs. intravascular lithotripsy: a comparative study in the treatment of calcified coronary lesions

Background Calcified coronary lesiosn (CCL) represent a major challenge in the setting of percutaneous coronary intervention (PCI). Many specific preparation techniques have been developed, but it remains unclear as to which one has better results. Purpose To compare the results and outcomes of rotational atherectomy (RA) and intravascular lithotripsy (IVL) in the treatment of severe CCL in a real-world setting. Methods This is a retrospective monocentric study on 110 adult patients with severe CCL who underwent urgent or scheduled PCI between 2022 and 2024. 64 patients were treated with IVL and 46 patients with RA. Demographic, clinical, and angiographic data was collected. In-hospital and 6-month major adverse cardiovascular events (MACE) and their predictive factors were analysed. Results The mean age was 76.9 years-old in the IVL group and 79.4 years old in the RA group. There was a strong male predominance in both groups. Angiographic success (defined by post-stenting residual stenosis visually estimated as < 30%, with a TIMI 3 flow and no severe dissection) was reached in 93.8% of IVL patients and 93.5% of RA patients. Procedural success (defined by in-hospital MACE-free angiographic success) was reached in 92.2% of IVL patients and 91.3% of RA patients. In-hospital MACE were exclusively cardiovascular deaths (IVL: 7.8%; RA: 8.7%). At 6-month, the MACE rate was 12.5% in the IVL group and 13.0% in the RA group. Myocardial infarction and target lesion revascularization rates were 3.1% and 4.7% in the IVL group, and 4.3% in the RA group. Conclusion No significant differences were found in terms of angiographic and procedural success rates. Both RA and IVL are safe and effective techniques for the preparation of severe CCL.Baseline characteristics of the cohorts Outcomes data