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Article 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.
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| http://dx.doi.org/10.1016/j.acvd.2025.06.075 | DOI Listing |
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