Moghadam Arman Soltani, Kakavand Nasim, Shirmard Fatemeh Ojaghi, Poopak Amirhossein, Anaraki Nazanin, Javadi Minoo, Jenab Yaser, Mehrani Mehdi, Khanipour Ramtin, Tehrani Behnam, Latib Azeem, Azizi Karim Al, Allana Salman, Kolte Dhaval, Hosseini Kaveh
Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Catheter Cardiovasc Interv. 2025 Aug;106(2):1142-1152. doi: 10.1002/ccd.31664. Epub 2025 Jun 4.
Calcific coronary lesions pose significant challenges to percutaneous coronary intervention (PCI), limiting stent delivery and expansion. Intravascular lithotripsy (IVL) and rotational atherectomy (RA) are widely used plaque modification techniques; however, comparative data on their effectiveness remain limited. We aimed to compare clinical and procedural outcomes between IVL and RA in the management of calcific coronary lesions.
PubMed, Embase, Scopus, and Cochrane Library were searched through January 2025 for randomized controlled trials (RCTs) and observational studies comparing IVL with RA in calcific coronary lesions undergoing PCI. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included all-cause mortality, myocardial infarction (MI), stroke, repeat revascularization, procedural outcomes, and minimum stent area (MSA). Random-effect models were used for outcome analysis, and meta-regression assessed the impact of baseline characteristics.
A total of 14 studies (2 RCTs, 12 observational; 2056 IVL patients, 3099 RA patients) were included. IVL and RA showed a comparable risk of MACE (OR 0.81; 95% CI 0.57-1.16; p: 0.26) and similar risks of all-cause mortality, MI, stroke, and repeat revascularization. IVL was associated with a lower risk of coronary perforation (OR 0.43; 95% CI 0.32-0.57; p < 0.001) and slow or no-reflow (OR 0.34; 95% CI 0.14-0.79; p 0.02). Additionally, IVL resulted in shorter procedure duration (SMD -0.30; 95% CI -0.61-0.00; p 0.05) and fluoroscopy time (SMD -0.41; 95% CI -0.62, -0.20; p 0.004). Post-procedural MSA was similar between IVL and RA.
IVL and RA demonstrated comparable efficacy in terms of MACE and clinical outcomes in patients with calcific coronary lesions undergoing PCI. However, IVL was associated with a lower risk of coronary perforation, slow or no-reflow phenomenon, and reduced procedure duration and fluoroscopy time, suggesting a potential procedural advantage over RA.
钙化性冠状动脉病变给经皮冠状动脉介入治疗（PCI）带来了重大挑战，限制了支架的输送和扩张。血管内碎石术（IVL）和旋磨术（RA）是广泛应用的斑块修饰技术；然而，关于它们有效性的比较数据仍然有限。我们旨在比较IVL和RA在钙化性冠状动脉病变管理中的临床和手术结果。
检索了截至2025年1月的PubMed、Embase、Scopus和Cochrane图书馆，以查找比较IVL与RA在接受PCI的钙化性冠状动脉病变中的随机对照试验（RCT）和观察性研究。主要结局是主要不良心血管事件（MACE）。次要结局包括全因死亡率、心肌梗死（MI）、中风、再次血运重建、手术结果和最小支架面积（MSA）。采用随机效应模型进行结局分析，Meta回归评估基线特征的影响。
共纳入14项研究（2项RCT，12项观察性研究；2056例IVL患者，3099例RA患者）。IVL和RA的MACE风险相当（OR 0.81；95%CI 0.57 - 1.16；p：0.26），全因死亡率、MI、中风和再次血运重建的风险相似。IVL与冠状动脉穿孔风险较低（OR 0.43；95%CI 0.32 - 0.57；p < 0.001）以及慢血流或无复流风险较低（OR 0.34；95%CI 0.14 - 0.79；p 0.02）相关。此外，IVL导致手术时间缩短（SMD -0.30；95%CI -0.61 - 0.00；p 0.05）和透视时间缩短（SMD -0.41；95%CI -0.62，-0.20；p 0.004）。术后IVL和RA的MSA相似。
在接受PCI的钙化性冠状动脉病变患者中，IVL和RA在MACE和临床结局方面显示出相当的疗效。然而，IVL与冠状动脉穿孔、慢血流或无复流现象的风险较低以及手术时间和透视时间缩短相关，提示其在手术方面可能优于RA。
