Calcified coronary lesions present a major challenge during percutaneous coronary intervention. Findings from a study presented at the European Society of Cardiology (ESC) Congress 2025 compared the safety and efficacy of rotational atherectomy and intravascular lithotripsy for lesion preparation.

The retrospective analysis included 110 adult patients, with 64 treated using intravascular lithotripsy and 46 with rotational atherectomy. Demographic, clinical, and angiographic data were collected, and in-hospital and six-month major adverse cardiovascular events were assessed. Patients in the intravascular lithotripsy group had a mean age of 76.9 years, while those in the rotational atherectomy group averaged 79.4 years. Both groups had a strong male predominance.

Angiographic success—defined as residual stenosis below 30%, TIMI 3 flow, and no severe dissection—was achieved in 93.8% of intravascular lithotripsy cases and 93.5% of rotational atherectomy cases. Procedural success, defined as in-hospital MACE-free angiographic success, reached 92.2% and 91.3%, respectively. In-hospital and six-month MACE rates were similar between groups, confirming that both techniques are safe and effective for severe calcified coronary lesions.