Intravascular lithotripsy vs. rotational atherectomy for severely calcified coronary lesions with concomitant tortuosity or angulation: a propensity-weighted real-world study from China
- 1Department of Cardiology, National Cardiovascular Disease Regional Center for Anhui, The First Affiliated Hospital of Anhui Medical University
- 2Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
Abstract
Background: Intravascular lithotripsy (IVL) is an emerging technique for the treatment of severely calcified coronary lesions, yet head-to-head evidence comparing its prognostic value against standard rotational atherectomy (RA) in real-world practice, particularly in patients with tortuous or angulated coronary anatomy, remains lacking.
Methods: This retrospective observational cohort study included 247 patients with severely calcified coronary lesions and concomitant tortuous or angulated anatomy who underwent percutaneous coronary intervention between January 2023 and March 2025, comprising 137 patients treated with RA and 110 treated with IVL. The primary endpoint was one-year composite major adverse cardiovascular events (MACE), encompassing all-cause mortality, target vessel revascularization, heart failure rehospitalization, in-stent restenosis, and stroke. Three complementary analytical strategies of escalating robustness, multivariable logistic regression, inverse probability of treatment weighting (IPTW) using a gradient boosted model (GBM), and doubly robust estimation, were employed to estimate the treatment effect of IVL vs. RA. Covariate balance was assessed using standardized mean differences (SMD ≤ 0.10).
Results: Baseline characteristics were broadly comparable between groups, with significant differences observed only in LDL-C, total cholesterol, and HDL-C (all P < 0.05). After IPTW, all 20 covariates achieved SMD ≤ 0.10. IPTW analysis demonstrated a significant 52% reduction in the odds of MACE with IVL (OR 0.48, 95% CI 0.25–0.90; P < 0.05), with directionally consistent estimates from multivariable logistic regression (OR 0.49, 0.18–1.23; P = 0.14) and doubly robust estimation (OR 0.48, 0.18–1.25; P = 0.13). Among secondary outcomes, one-year heart failure rehospitalization was significantly lower with IVL (OR 0.22, 95% CI 0.03–0.78; P = 0.03); no significant differences were observed for mortality, target vessel revascularization, stroke, or in-stent restenosis.
Conclusions: In this retrospective cohort of patients with severely calcified coronary lesions, all of whom had concomitant tortuous or angulated anatomy, IVL was associated with a lower risk of one-year MACE compared with RA, an effect driven primarily by a reduction in heart failure rehospitalisation. The consistency across three analytical models suggests robustness of this finding, although confirmation in adequately powered randomised controlled trials is warranted.
Related
- Stent-less percutaneous coronary intervention for a severely calcified coronary lesion using combined orbital atherectomy and intravascular lithotripsy followed by drug-coated balloon: case report
- Successful excimer laser coronary atherectomy after failed rotational atherectomy in a balloon-uncrossable chronic total occlusion of the left anterior descending artery
- Vascular response and silent micro-embolization after rotational atherectomy and drug-coated balloon angioplasty: insights from micro-computed tomography and histology
- Intravascular lithotripsy for highly calcified carotid stenoses: distal (filter) protection may not suffice
- Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis
BibTeX
@article{kong2026intravascular,
title = {{Intravascular lithotripsy vs. rotational atherectomy for severely calcified coronary lesions with concomitant tortuosity or angulation: a propensity-weighted real-world study from China}},
author = {Xiangyong Kong and Ben Hu and Zhiqing Guo and Yahao Zhang and Jun Xie},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = nov,
doi = {10.3389/fcvm.2026.1943238},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1943238/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Intravascular lithotripsy vs. rotational atherectomy for severely calcified coronary lesions with concomitant tortuosity or angulation: a propensity-weighted real-world study from China
AU - Xiangyong Kong
AU - Ben Hu
AU - Zhiqing Guo
AU - Yahao Zhang
AU - Jun Xie
PY - 2026
DA - 2026/11/02
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1943238
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1943238/full
AB - Background: Intravascular lithotripsy (IVL) is an emerging technique for the treatment of severely calcified coronary lesions, yet head-to-head evidence comparing its prognostic value against standard rotational atherectomy (RA) in real-world practice, particularly in patients with tortuous or angulated coronary anatomy, remains lacking. Methods: This retrospective observational cohort study included 247 patients with severely calcified coronary lesions and concomitant tortuous or angulated anatomy who underwent percutaneous coronary intervention between January 2023 and March 2025, comprising 137 patients treated with RA and 110 treated with IVL. The primary endpoint was one-year composite major adverse cardiovascular events (MACE), encompassing all-cause mortality, target vessel revascularization, heart failure rehospitalization, in-stent restenosis, and stroke. Three complementary analytical strategies of escalating robustness, multivariable logistic regression, inverse probability of treatment weighting (IPTW) using a gradient boosted model (GBM), and doubly robust estimation, were employed to estimate the treatment effect of IVL vs. RA. Covariate balance was assessed using standardized mean differences (SMD ≤ 0.10). Results: Baseline characteristics were broadly comparable between groups, with significant differences observed only in LDL-C, total cholesterol, and HDL-C (all P < 0.05). After IPTW, all 20 covariates achieved SMD ≤ 0.10. IPTW analysis demonstrated a significant 52% reduction in the odds of MACE with IVL (OR 0.48, 95% CI 0.25–0.90; P < 0.05), with directionally consistent estimates from multivariable logistic regression (OR 0.49, 0.18–1.23; P = 0.14) and doubly robust estimation (OR 0.48, 0.18–1.25; P = 0.13). Among secondary outcomes, one-year heart failure rehospitalization was significantly lower with IVL (OR 0.22, 95% CI 0.03–0.78; P = 0.03); no significant differences were observed for mortality, target vessel revascularization, stroke, or in-stent restenosis. Conclusions: In this retrospective cohort of patients with severely calcified coronary lesions, all of whom had concomitant tortuous or angulated anatomy, IVL was associated with a lower risk of one-year MACE compared with RA, an effect driven primarily by a reduction in heart failure rehospitalisation. The consistency across three analytical models suggests robustness of this finding, although confirmation in adequately powered randomised controlled trials is warranted.
SN - 2297-055X
ER -