Intravascular Lithotripsy Versus Rotational Atherectomy for Calcified Coronary Lesions: A Systematic Review and an Updated Meta-Analysis of Clinical Outcomes.

Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Published Date: May 12, 2025

Abstract

BACKGROUND: Severe coronary artery calcification (CAC) remains a significant challenge in interventional cardiology, especially in elderly and comorbid patients, such as diabetes or chronic kidney disease. CAC often leads to complications such as stent thrombosis and restenosis, therefore leading to bad clinical outcomes and increased major adverse cardiovascular events (MACE) rates. Traditional approaches, including rotational atherectomy (RA), are commonly used to treat calcified plaques; however, are limited by procedural complexity, length of procedures, and risk of vascular injury. In contrast, intravascular lithotripsy (IVL) has emerged as a novel therapy using acoustic pressure waves to break calcified plaques with minimal vascular trauma. Despite its increasing use, direct comparisons between IVD and RA in the context of severe CAC are scant and leave critical evidence gaps for therapy optimization. This study compares IVL and RA outcomes to improve strategies for severe CAC management.

Authors

  • Ricardo Fonseca Oliveira Suruagy-Motta
    Department of Medicine, Cesmac University Center, Maceió, Brazil.
  • Lucas Silva Cabeça
    Department of Medicine, Federal University of Pará, Belém, Brazil.
  • Anderson Matheus Pereira Da Silva
    Department of Pharmacology, Federal University of the São Francisco Valley, Petrolina, Brazil.
  • Gabriel Rezende Neves
    Department of Medicine, State University of Pará, Belém, Brazil.
  • Maria Tereza Camarotti
    Department of Medicine, Pernambuco's Health College, Recife, Brazil.
  • Luan Cavalcante Vilaça Lima
    Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
  • Ariane Barros Mesquita Cunha
    Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
  • Edmundo Damiani Bertoli
    Department of Internal Medicine, Marieta Konder Bornhausen Hospital, Itajaí, Brazil.
  • Laila Leite Pacheco Vieira
    Department of Medicine, Cesmac University Center, Maceió, Brazil.
  • Thiago José Matos Rocha
    Department of Medicine, Cesmac University Center, Maceió, Brazil.
  • Marcos Danillo Oliveira
    Department of Interventional Cardiology, Escola Paulista de Medicina-EPM/UNIFESP, São Paulo, Brazil.

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