JRSM cardiovascular disease · 2026
Coronary atherectomy versus balloon angioplasty before drug-eluting stent implantation in severely calcified lesions: A systematic review and meta-analysis.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kasimieh Omar, Guntupalli Yashaswi, Patel Prapti Atul, Abraham Lydia Susan, Pulickal Thomas Viji, Bhuiyan Md Arif Hasan, Feyisa Milikyas Abera, Bushnaq Mohammed, Reddy Rohit Mote, Mokhtassi Shiva, Ejaz Arooba, Ali Alsubari Asma'a Munasar, Vats Vaibhav, Almas Talal, Cheema Huzaifa Ahmad
Аннотация
BACKGROUND: Severe coronary calcification can impede stent delivery and affect long-term outcomes. Few trials have compared coronary atherectomy with balloon-first strategies for lesion preparation before drug-eluting stent (DES) implantation.
METHODS: We searched MEDLINE, Embase, and the Cochrane Library through October 2025 for randomized controlled trials (RCTs) comparing coronary atherectomy with balloon angioplasty for lesion preparation before DES implantation in severely calcified coronary lesions.
RESULTS: Across three RCTs, there was no significant difference in major adverse cardiovascular events between atherectomy and balloon angioplasty (risk ratio [RR] 1.05, 95% confidence interval [CI] 0.85-1.30; I 2 = 0%). Strategy success trended higher with atherectomy but did not reach statistical significance (RR 1.10, 95% CI 0.99-1.23; I 2 = 84%). No significant differences were observed for myocardial infarction (RR 1.06, 95% CI 0.80-1.42; I 2 = 0%), any revascularization (RR 0.68, 95% CI 0.25-1.82; I 2 = 83%), target lesion revascularization (RR 0.88, 95% CI 0.57-1.37; I 2 = 83%), target vessel revascularization (RR 0.89, 95% CI 0.64-1.24; I 2 = 0%), stent thrombosis (RR 2.75, 95% CI 0.94-8.06; I 2 = 0%), cardiac mortality (RR 1.49, 95% CI 0.93-2.40; I 2 = 0%), all-cause mortality (RR 1.10, 95% CI 0.79-1.54; I 2 = 0%), or procedural complications (RR 0.95, 95% CI 0.69-1.30; I 2 = 3%).
CONCLUSIONS: Our meta-analysis showed that routine atherectomy was comparable with balloon angioplasty in severely calcified coronary lesions. These findings support a selective, imaging-guided balloon-first strategy, reserving atherectomy for lesions that remain undilatable or uncrossable. Randomized studies of imaging-guided algorithms and emerging technologies are needed to define optimal lesion-specific strategies.
METHODS: We searched MEDLINE, Embase, and the Cochrane Library through October 2025 for randomized controlled trials (RCTs) comparing coronary atherectomy with balloon angioplasty for lesion preparation before DES implantation in severely calcified coronary lesions.
RESULTS: Across three RCTs, there was no significant difference in major adverse cardiovascular events between atherectomy and balloon angioplasty (risk ratio [RR] 1.05, 95% confidence interval [CI] 0.85-1.30; I 2 = 0%). Strategy success trended higher with atherectomy but did not reach statistical significance (RR 1.10, 95% CI 0.99-1.23; I 2 = 84%). No significant differences were observed for myocardial infarction (RR 1.06, 95% CI 0.80-1.42; I 2 = 0%), any revascularization (RR 0.68, 95% CI 0.25-1.82; I 2 = 83%), target lesion revascularization (RR 0.88, 95% CI 0.57-1.37; I 2 = 83%), target vessel revascularization (RR 0.89, 95% CI 0.64-1.24; I 2 = 0%), stent thrombosis (RR 2.75, 95% CI 0.94-8.06; I 2 = 0%), cardiac mortality (RR 1.49, 95% CI 0.93-2.40; I 2 = 0%), all-cause mortality (RR 1.10, 95% CI 0.79-1.54; I 2 = 0%), or procedural complications (RR 0.95, 95% CI 0.69-1.30; I 2 = 3%).
CONCLUSIONS: Our meta-analysis showed that routine atherectomy was comparable with balloon angioplasty in severely calcified coronary lesions. These findings support a selective, imaging-guided balloon-first strategy, reserving atherectomy for lesions that remain undilatable or uncrossable. Randomized studies of imaging-guided algorithms and emerging technologies are needed to define optimal lesion-specific strategies.