Comparison of intravascular lithotripsy and rotational atherectomy for the treatment of severe coronary calcification with different morphologies

Background This study aimed to compare the efficacies of intravascular lithotripsy (IVL) and rotational atherectomy (RA) for treating severe coronary calcification lesions and their effects on different calcification morphologies. Methods This was a single-center, retrospective study. Patients with severe coronary calcification who underwent IVL or RA for treatment followed by stent implantation between January 2023 and November 2023 were enrolled. The primary endpoint was the minimum stent area measured using intravascular ultrasound. The secondary endpoint was the 1-year target vessel failure rate. The calcified lesions were divided into segments at intervals of 1 mm and categorized into the following three groups based on calcification angle and morphology: calcified nodules, eccentric calcification, and concentric calcification. The stent area and symmetry after IVL and RA were compared across different calcification morphologies. Results Eighteen and 17 patients were enrolled in the IVL and RA groups, respectively. No significant difference in minimum stent area was observed between the two groups: 5.38 ± 1.17 mm² for IVL and 5.08 ± 1.21 mm² for RA (P = 0.46). The target vessel failure rates were 16.67% for IVL and 11.76% for RA (P = 0.68). The IVL and RA groups had 453 and 390 calcified segments, respectively. The stent areas for calcified nodule segments were similar for both groups: 6.67 (5.15, 7.75) mm² vs. 6.07 (5.33, 10.17) mm² (P = 0.60). The stent area in the IVL group was larger than that in the RA group for concentric calcification segments: 6.34 (5.44, 7.28) mm² vs. 5.15 (5.42, 6.78) mm² (P = 0.047). Conclusions IVL and RA had comparable efficacies in patients with severe coronary calcification. IVL was more effective than RA for treating concentric calcifications.