Comparative efficacy and safety of intravascular lithotripsy versus rotational atherectomy in coronary artery calcification: An updated meta-analysis - 14/12/25
, Muhammad Faiq Umar a, Alan Garcia b, Thomas Fretz b, Ricky E. Lemus-Zamora b, Chadi Alraies c, Tarique Ahmed d, Anas Alharbi e, Ramesh Daggubati e, Yasar Sattar eGraphical abstract |
Highlights |
• | CAC poses a significant challenge during PCI, increasing the risk of complications. |
• | IVL was compared with RA in the management of CAC. |
• | IVL was associated with a reduced risk of coronary perforation compared with RA. |
• | IVL was associated with a higher incidence of procedural success compared with RA. |
• | No difference in all-cause death, MI, slow/no-reflow and TVR between IVL and RA. |
Abstract |
Background |
The presence of coronary artery calcification during percutaneous coronary intervention is associated with an increased risk of complications and poor outcomes. Comparison of the efficacy and safety of intravascular lithotripsy and rotational atherectomy in coronary artery calcification has always been a topic of debate in the literature.
Aim |
To present the most recent comparative analysis of these two calcium debulking techniques.
Methods |
A search was conducted in online databases, including PubMed, Web of Science and the Cochrane Library. We performed a meta-analysis to find the difference between intravascular lithotripsy and rotational atherectomy regarding all-cause death, myocardial infarction, coronary perforation, slow/no-reflow, target vessel revascularization and procedural success. Using a random effects model, the results were reported as risk ratios.
Results |
A total of nine studies with 2203 patients (intravascular lithotripsy, n = 1004; rotational atherectomy, n = 1199) were selected. Intravascular lithotripsy was associated with a reduced risk of coronary perforation (risk ratio 0.38, 95% confidence interval 0.23–0.62; P = 0.0001) and increased procedural success (risk ratio 1.04, 95% confidence interval 1.02–1.06; P = 0.0004). There was no significant difference between intravascular lithotripsy and rotational atherectomy in terms of the risk of all cause death, myocardial infarction, target vessel revascularization and slow/no-reflow.
Conclusions |
Intravascular lithotripsy was associated with a lower risk of coronary perforation and higher procedural success compared with rotational atherectomy in the management of coronary artery calcification. However, no significant differences were observed between intravascular lithotripsy and RA in terms of all-cause death, myocardial infarction, target vessel revascularization and slow/no-reflow. Given the predominance of retrospective studies in the analysis, randomized controlled trials with long-term follow-up are needed to better identify patient populations most likely to benefit, as well as to compare the long-term clinical outcomes of these two plaque modification strategies.
Le texte complet de cet article est disponible en PDF.Keywords : Coronary artery calcification, Intravascular lithotripsy, Rotational atherectomy, Percutaneous coronary intervention, Calcium modification techniques
Plan
Vol 118 - N° 12
P. 661-670 - décembre 2025 Retour au numéro
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