Comparison of Coronary Intravascular Lithotripsy and Rotational Atherectomy in the Modification of Severely Calcified Stenoses

Debulking techniques are often necessary for successful lesion preparation in percutane-ous coronary intervention. The aim of this study was to compare plaque modification of severely calcified lesions by coronary intravascular lithotripsy (IVL) with that of rota-tional atherectomy (RA) using optical coherence tomography (OCT). ROTA.shock was a 1:1 randomized, prospective, double-arm, multicenter noninferiority trial designed to compare final minimal stent area after IVL with RA for lesion preparation in percutane-ous coronary interventional treatment of severely calcified lesions. On the basis of OCT acquired before and immediately after IVL or RA in 21 of the 70 patients included, we performed a detailed analysis of the modification of the calcified plaque. After RA and IVL, calcified plaque fractures were present in 14 of the patients (67%), with a signifi-cantly greater number of fractures after IVL (3.23 +/- 0.49) than after RA (1.67 +/- 0.52; p < 0.001). Plaque fractures after IVL were longer than after RA (IVL: 1.67 +/- 0.43 mm vs RA: 0.57 +/- 0.55 mm; p = 0.01), resulting in a greater total volume of the fractures (IVL: 1.47 +/- 0.40 mm3 vs RA: 0.48 +/- 0.27 mm3; p = 0.003). Use of RA was associated with a greater acute lumen gain than was use of IVL (RA: 0.46 +/- 0.16 mm2 vs IVL: 0.17 +/- 0.14 mm2; p = 0.03). In conclusion, we were able to show differences in plaque modification of calcified coronary lesions by OCT: although RA leads to a greater acute lumen gain, IVL induces more and longer fractures of the calcified plaque. (c) 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;197:93-100)