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Comparative Study
. 2025 Jan 15:235:37-43.
doi: 10.1016/j.amjcard.2024.10.018. Epub 2024 Oct 24.

Intravascular Lithotripsy Versus Rotational Atherectomy in Coronary Chronic Total Occlusions: Analysis from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention Registry

Pedro E P Carvalho  1 , Dimitrios Strepkos  1 , Michaella Alexandrou  1 , Deniz Mutlu  1 , Ozgur Selim Ser  1 , James W Choi  2 , Sevket Gorgulu  3 , Farouc A Jaffer  4 , Raj Chandwaney  5 , Khaldoon Alaswad  6 , Mir B Basir  6 , Lorenzo Azzalini  7 , Ramazan Ozdemir  8 , Mahmut Uluganyan  8 , Jaikirshan Khatri  9 , Laura Young  9 , Paul Poommipanit  10 , Nazif Aygul  11 , Rhian Davies  12 , Oleg Krestyaninov  13 , Dmitrii Khelimskii  13 , Omer Goktekin  14 , Ahmet Akyel  14 , Hasim Tuner  14 , Nidal Abi Rafeh  15 , Ahmed Elguindy  16 , Bavana V Rangan  1 , Olga C Mastrodemos  1 , Konstantinos Voudris  1 , M Nicholas Burke  1 , Yader Sandoval  1 , Emmanouil S Brilakis  17
Affiliations
Comparative Study

Intravascular Lithotripsy Versus Rotational Atherectomy in Coronary Chronic Total Occlusions: Analysis from the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention Registry

Pedro E P Carvalho et al. Am J Cardiol. .

Abstract

There are limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024. Of 15,690 patients who underwent CTO PCI during the study period, 436 (2.78%) underwent IVL and 381 (2.45%) RA. Patients treated with IVL had more co-morbidities and more complex CTO lesions. Antegrade wiring was the most used initial and successful crossing strategy for lesions treated with both IVL and RA, although the retrograde approach was more frequently used in IVL cases. Procedure and fluoroscopy times, and air kerma radiation doses and contrast volumes, were greater in patients treated with RA than those treated with IVL. There were no significant differences between the groups in technical success (97.2% vs 95.3%, p = 0.20), procedural success (94.7% vs 91.8%, p = 0.14), and in-hospital major adverse cardiac events (MACEs) (3.0% vs 4.2%, p = 0.47). However, coronary artery perforations were more frequent in patients who underwent RA (9.5% vs 3.2%, p <0.001). Multivariable logistic regression analysis revealed that IVL compared with RA was not independently associated with technical success, procedural success, or in-hospital MACE. In patients who undergo CTO PCI, IVL is associated with similar in-hospital MACE, technical success, and procedural success but lower incidence of coronary artery perforation compared with RA.

Keywords: calcium modification; chronic total occlusion; intravascular lithotripsy; percutaneous coronary intervention; rotational atherectomy.

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Conflict of interest statement

Declaration of competing interest Dr. Jaffer reports sponsored research for Canon, Siemens, Shockwave, Teleflex, Boston Scientific, HeartFlow, and Neovasc; consultant/speakers fees from Magenta Medical, Philips, Biotronik, Mercator, Terumo (Canon), Abiomed, Shockwave, DurVena, Intravascular Imaging Inc., Medtronic, and FastWave; equity interest in Intravascular Imaging Inc., DurVena, and FastWave; and Massachusetts General Hospital licensing arrangements: Terumo, Canon, and SpectraWAVE, for which Dr. Jaffer has the right to receive royalties. Dr. Azzalini received consulting fees from Teleflex, Abiomed, GE Healthcare (Little Chalfont, United Kingdom), Reflow Medical, Shockwave, and Cardiovascular Systems, Inc.; received a research grant by Abiomed; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical. Dr. Davies receives speaking honoraria from Abiomed, Asahi Intec, Boston Sci, Medtronic, Shockwave, and Teleflex; and serves on advisory boards for Abiomed, Avinger, Boston Sci, Medtronic, Rampart, and Shockwave. Dr. Sandoval receives consulting/speaker honoraria from Abbott Diagnostics, Roche Diagnostics, Zoll, and Philips; is JACC Advances associate editor; and reports Patent 20,210,401,347. Dr. Brilakis receives consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medtronic, and Teleflex; research support from Boston Scientific, GE Healthcare; is owner, Hippocrates LLC; and is shareholder in MHI Ventures, Cleerly Health, Stallion Medical. The remaining authors have no competing interests to declare.

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