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Meta-Analysis
. 2025 Aug;106(2):1142-1152.
doi: 10.1002/ccd.31664. Epub 2025 Jun 4.

Intravascular Lithotripsy Versus Rotational Atherectomy in the Management of Calcific Coronary Lesions: A Systematic Review and Meta-Analysis

Arman Soltani Moghadam  1 , Nasim Kakavand  2 , Fatemeh Ojaghi Shirmard  1 , Amirhossein Poopak  3 , Nazanin Anaraki  1 , Minoo Javadi  1 , Yaser Jenab  1 , Mehdi Mehrani  1 , Ramtin Khanipour  4 , Behnam Tehrani  5 , Azeem Latib  6 , Karim Al Azizi  7 , Salman Allana  8 , Dhaval Kolte  9 , Kaveh Hosseini  1
Affiliations
Meta-Analysis

Intravascular Lithotripsy Versus Rotational Atherectomy in the Management of Calcific Coronary Lesions: A Systematic Review and Meta-Analysis

Arman Soltani Moghadam et al. Catheter Cardiovasc Interv. 2025 Aug.

Abstract

Background and aims: Calcific coronary lesions pose significant challenges to percutaneous coronary intervention (PCI), limiting stent delivery and expansion. Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are widely used plaque modification techniques; however, comparative data on their effectiveness remain limited. We aimed to compare clinical and procedural outcomes between IVL and RA in the management of calcific coronary lesions.

Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through January 2025 for randomized controlled trials (RCTs) and observational studies comparing IVL with RA in calcific coronary lesions undergoing PCI. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, myocardial infarction (MI), stroke, repeat revascularization, procedural outcomes, and minimum stent area (MSA). Random-effect models were used for outcome analysis, and meta-regression assessed the impact of baseline characteristics.

Results: A total of 14 studies (2 RCTs, 12 observational; 2056 IVL patients, 3099 RA patients) were included. IVL and RA showed a comparable risk of MACE (OR 0.81; 95% CI 0.57-1.16; p: 0.26) and similar risks of all-cause mortality, MI, stroke, and repeat revascularization. IVL was associated with a lower risk of coronary perforation (OR 0.43; 95% CI 0.32-0.57; p < 0.001) and slow or no-reflow (OR 0.34; 95% CI 0.14-0.79; p 0.02). Additionally, IVL resulted in shorter procedure duration (SMD -0.30; 95% CI -0.61-0.00; p 0.05) and fluoroscopy time (SMD -0.41; 95% CI -0.62, -0.20; p 0.004). Post-procedural MSA was similar between IVL and RA.

Conclusion: IVL and RA demonstrated comparable efficacy in terms of MACE and clinical outcomes in patients with calcific coronary lesions undergoing PCI. However, IVL was associated with a lower risk of coronary perforation, slow or no-reflow phenomenon, and reduced procedure duration and fluoroscopy time, suggesting a potential procedural advantage over RA.

Keywords: calcific coronary lesions; calcium modification techniques; intravascular lithotripsy; percutaneous coronary intervention; rotational atherectomy.

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References

    1. A. Kaul, P. S. Dhalla, A. Bapatla, et al., “Current Treatment Modalities for Calcified Coronary Artery Disease: A Review Article Comparing Novel Intravascular Lithotripsy and Traditional Rotational Atherectomy,” Cureus 12, no. 10 (2020): e10922.
    1. J. J. Wong, S. Umapathy, Y. S. Keh, et al., “Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real‐World Patients,” Korean Circulation Journal 52, no. 4 (2022): 288–300.
    1. R. Hemetsberger, M. Abdelghani, R. Toelg, et al., “Impact of Coronary Calcification on Clinical Outcomes After Implantation of Newer‐Generation Drug‐Eluting Stents,” Journal of the American Heart Association 10, no. 12 (2021): e019815.
    1. D. Sukul, M. Seth, R. D. Madder, et al., “Contemporary Trends and Outcomes of Intravascular Lithotripsy in Percutaneous Coronary Intervention,” JACC: Cardiovascular Interventions 17, no. 15 (2024): 1811–1821.
    1. F. Blachutzik, S. Meier, M. Weissner, et al., “Coronary Intravascular Lithotripsy and Rotational Atherectomy for Severely Calcified Stenosis: Results From the ROTA.Shock Trial,” Catheterization and Cardiovascular Interventions 102, no. 5 (2023): 823–833.

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