Comparison of Short-Term Clinical Outcomes Between Intravascular Lithotripsy and Rotational Atherectomy for Calcified Coronary Stenosis in Patients With Acute Coronary Syndrome

• Published in: Circulation Reports Vol. 7; no. 8; pp. CR-25-0086 - 618
• Main Authors: Honda, Yasuhiro, Nishihira, Kensaku, Kuriyama, Nehiro, Takamatsu, Makoto, Yamamoto, Keisuke, Nishino, Shun, Kadooka, Kosuke, Kudo, Takeaki, Ogata, Kenji, Kimura, Toshiyuki, Ayabe, Kengo, Ashikaga, Keiichi, Shibata, Yoshisato
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 08.08.2025
• Subjects: Acute coronary syndrome; Calcified coronary stenosis; Cardiovascular Intervention; Intravascular lithotripsy; Original; Rotational atherectomy; Calcified coronary stenosis; Rotational atherectomy; Acute coronary syndrome; Intravascular lithotripsy
• ISSN: 2434-0790; 2434-0790
• DOI: 10.1253/circrep.CR-25-0086

Background: The optimal revascularization strategy for calcified lesions in patients with acute coronary syndrome (ACS) remains unclear. This study aimed to compare the short-term outcomes of intravascular lithotripsy (IVL) and rotational atherectomy (RA) for patients with ACS resulting from calcified lesions.Methods and Results: Among 3,556 consecutive patients with ACS who underwent primary percutaneous coronary intervention (PCI) between 2016 and 2024, we retrospectively analyzed 52 patients who received drug-eluting stents with either IVL (n=24) or RA (n=28) for calcified lesions. The primary outcome was the incidence of major adverse cardiovascular events (MACE). In addition, we evaluated slow-flow or no-reflow phenomena incidence during PCI and the procedural success rate. Compared with patients with RA, those with IVL had a smaller preprocedural minimum lumen diameter and a larger preprocedural reference vessel diameter. Primary outcomes and procedural success rates were comparable between both groups. However, the slow-flow or no-reflow incidence was significantly lower in the IVL group than in the RA group. After adjusting for confounders, IVL was independently associated with a lower slow-flow or no-reflow incidence.Conclusions: In patients with ACS due to calcified lesions, there was no significant difference in 30-day MACE incidence between both groups. However, slow-flow incidence was lower in the IVL group.