Background

Severe coronary artery calcification is associated with poor procedural and clinical outcomes in patients undergoing percutaneous coronary intervention. Rotational atherectomy (RA) and intravascular lithotripsy (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 addition, the occurrence of major adverse cardiovascular events (MACE, defined as the composite of all-cause mortality, 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.