Comparison of Coronary Intravascular Lithotripsy and Rotational Atherectomy in the Modification of Severely Calcified Stenoses

Debulking techniques are often necessary for successful lesion preparation in percutane-ous coronary intervention. The aim of this study was to compare plaque modification of severely calcified lesions by coronary intravascular lithotripsy (IVL) with that of rota-tional atherectomy (RA) using optical coherence tomography (OCT). ROTA.shock was a 1:1 randomized, prospective, double-arm, multicenter noninferiority trial designed to compare final minimal stent area after IVL with RA for lesion preparation in percutane-ous coronary interventional treatment of severely calcified lesions. On the basis of OCT acquired before and immediately after IVL or RA in 21 of the 70 patients included, we performed a detailed analysis of the modification of the calcified plaque. After RA and IVL, calcified plaque fractures were present in 14 of the patients (67%), with a signifi-cantly greater number of fractures after IVL (3.23 +/- 0.49) than after RA (1.67 +/- 0.52; p < 0.001). Plaque fractures after IVL were longer than after RA (IVL: 1.67 +/- 0.43 mm vs RA: 0.57 +/- 0.55 mm; p = 0.01), resulting in a greater total volume of the fractures (IVL: 1.47 +/- 0.40 mm3 vs RA: 0.48 +/- 0.27 mm3; p = 0.003). Use of RA was associated with a greater acute lumen gain than was use of IVL (RA: 0.46 +/- 0.16 mm2 vs IVL: 0.17 +/- 0.14 mm2; p = 0.03). In conclusion, we were able to show differences in plaque modification of calcified coronary lesions by OCT: although RA leads to a greater acute lumen gain, IVL induces more and longer fractures of the calcified plaque. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;197:93-100)

Automated summary

This study aimed to compare the effects of coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA) on severely calcified lesions. Based on OCT analysis, it was found that IVL induced more and longer fractures of the calcified plaque, while RA achieved a greater acute lumen gain.