Rotational Atherectomy With or Without Intravascular Lithotripsy for Patients With Heavy Coronary Artery Calcification.

Recent advances in calcium debulking technologies may contribute to development of new percutaneous coronary intervention (PCI) paradigms for patients with heavy coronary artery calcification (CAC). Comparative data on safety and clinical efficacy of a combination strategy including rotational atherectomy (RA) and intravascular lithotripsy (IVL) is lacking. The aim of the study was to determine the addional effect of IVL when performed after RA in patients with heavy CAC. All patients with heavy CAC undergoing PCI with RA between September 2021 and August 2023 at a tertiary care center were prospectively enrolled. Patients additionally treated with IVL were compared with patients treated without IVL. Primary outcomes were incidence of final serious angiographic complications (a composite of National Heart, Lung and Blood Institute type C-F dissection, cardiac tamponade, abrupt vessel closure and slow/no flow), and of 30-day major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, stroke and target vessel revascularization. A total of 1,365 patients were enrolled, of whom 150 (11%) patients treated with RA + IVL and 1,215 patients (89%) with RA. Incidence of final serious angiographic complications occurred in 5 (3.3%) patients in RA + IVL group and 56 (4.6%) patients in RA group (p = 0.476). Propensity score stratified logistic regression analysis confirmed similar odds in RA + IVL versus RA groups (odds ratio [OR]: 0.63; 95% CI: 0.24 to 1.63). The risk of 30-day MACE (OR: 0.89; 95% CI: 0.30 to 2.64) was similar between groups. In conclusion, our results suggest a PCI strategy including RA followed by IVL holds a short-term safety and clinical efficacy profile similar to that of a strategy including RA.