Effective preparation of heavily calcified coronary lesions is essential for optimal stent expansion and long-term patency. A prospective OCT substudy from the ECLIPSE trial, published in Circulation: Cardiovascular Interventions, compared OA with BA.

The randomized trial included 2005 patients with severely calcified coronary lesions undergoing drug-eluting stent implantation. Postprocedural OCT data were available for 286 OA-treated lesions and 292 BA-treated lesions. Angiography confirmed 98.1% of lesions were severely calcified. Median maximal calcium arc measured 204°, calcium thickness 0.85 mm, and calcium length 22.0 mm.

OA generated more extensive calcium fractures, producing greater fracture number, depth, and total length. However, MSA at the site of maximal calcification remained similar with OA vs BA (7.44 vs 7.05 mm²; P=0.08), as did the MSA across the entire stent (5.86 vs 5.57 mm²; P=0.10). One-year TVF was also not significantly different (7.8% vs 6.6%; P=0.61).

These findings indicate that enhanced mechanical calcium modification achieved with OA does not necessarily translate into larger acute stent expansion or improved 1-year clinical outcomes. Selection of calcium-modifying strategy may require individualized, lesion-specific decision-making.