Background: Calcium modification techniques have significantly changed over time, particularly after the approval of coronary intravascular lithotripsy in 2021.We assessed the evolving landscape of calcium modification methodology during left main (LM) percutaneous coronary intervention (PCI) and the impact of intravascular lithotripsy.Methods: LM PCI cases (n=863) were identified in the IU Health multicenter cath lab registry which includes 7 participating hospitals between 2015-2022.Procedural details were recorded prospectively for the registry and use of rotablation, balloon shockwave lithotripsy, and orbital atherectomy was analyzed according to the year performed.Results: The average age of patients undergoing LM PCI was 69 years; 66% were male (n=568) and 34% were female (n=295).Out of the 863 procedures performed, 18.8% (n = 163) utilized calcium modification.Overtime the use of rotablation decreased from being used in 12% of cases at its peak in 2016 to 1% by 2022 (Figure 1).Orbital atherectomy also showed a decline in use, though less drastic.Its use peaked at 21% in 2019, then decreased to 16% in 2022.A chi square test of independence determined that there was a significant difference in rotablation and orbital atherectomy use before and after the introduction of balloon lithotripsy in 2021 ( 2 = 66, p <0.001).Conclusions: Overall, rotablation use and to a lesser extent orbital atherectomy use decreased over time particularly after the introduction of balloon shockwave lithotripsy for coronary interventions.
Runkana et al. (2026) studied this question.