Efficacy and Safety of Intravascular Lithotripsy Versus Rotational Atherectomy in Balloon-Crossable Heavily Calcified Coronary Lesions

Background: Severe coronary artery calcification is associated with poor procedural and clinical outcomes in pa-tients undergoing percutaneous coronary intervention. Rotational atherectomy (RA) and intravascular litho-tripsy (IVL) are techniques used to optimize lesion preparation and facilitate stent implantation in this anatomical scenario. However, their comparative efficacy and safety remain unknown. Methods: We retrospectively analyzed 101 patients who underwent PCI utilizing RA or IVL for lesion preparation in heavily calcified balloon-crossable coronary stenosis. The primary endpoint was procedural success. In addi-tion, the occurrence of major adverse cardiovascular events (MACE, defined as the composite of all-cause mortal-ity, target lesion revascularization(TLR), stroke and stent thrombosis (ST)) at 6-months was analyzed. Results: High rates of procedural success were achieved in both RA and IVL (82 % vs. 92 %; p = 0.25), with a low in hospital complication rate (8 % vs. 4 %; p = 0.678). No significant differences were found in overall MACE at 6-months (12 % vs 6 %; P = 0.487), death (8 % vs. 2 %; p = 0.362), TLR (2 % vs. 2 %; p = 1.000), stroke (2 % vs. 2 %; P = 1.000) or ST (2 % vs. 0 %; P = 1.000). Moreover, IVL is associated with a significantly shorter fluoroscopy time (32 [22-45] vs 26 [16-37]; P = 0.041). Conclusions: Both IVL and RA are safe and effective methods for treatment of heavily calcified coronary lesions with similar outcomes at short term follow up.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).