Comparison of the efficacy of intravascular lithotripsy and rotational atherectomy as adjunctive therapy before drug-eluting stent implantation in calcified coronary lesions (CCS- Coronary Calcification Study).

BACKGROUND

This prospective randomized study compares the efficacy of novel intravascular lithotripsy (IVL) to the standard preparation of calcified coronary lesions based on rotational atherectomy (RA).

METHODS

A total of 50 patients with 52 calcified lesions were enrolled in the study and randomized 1:1 to be treated with IVL or RA followed by drug-eluting stent (DES) implantation. The procedural success was chosen as a primary endpoint and the 12-month late lumen loss (LLL) as measured by quantitative coronarography, the incidence of binary in-stent restenosis (ISR), 12-month major adverse cardiac events (MACE) and target lesion failure (TLF) served as secondary angiographic and clinical endpoints.

RESULTS

Procedural success was achieved in 21 patients (84.0%) in the IVL group and in 24 patients (96%) in the RA group (p = 0.349). The secondary endpoints, including 12-month LLL (0.12 mm [IQR: - 0.06; 0.68] vs. 0.61 mm [IQR: 0.22; 0.72]; p = 0.084), the incidence of 12-month binary ISR (11.1% vs. 8.0%; p >0.999), MACE (18.5% vs. 8.0%; p = 0.422), TLR (14.8% vs. 8.0%; p = 0.670) or TLF (18.5% vs. 8.0%; p = 0.422) did not show significant differences between the IVL and RA groups.

CONCLUSION

Despite different approaches to the treatment of calcified coronary lesions, both therapeutic techniques achieved similar procedural, angiographic and clinical results. (ClinicalTrials.gov NCT04428177).