Intravascular lithotripsy reduces mortality risk and MACE in calcified coronary lesions compared to rotational atherectomyIntravascular lithotripsy shows better safety for calcified heart lesions

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Published July 9, 2026 Study authors: Motawea Karam R, Makky Eman, Abdelwahab Abdelrhman M, Khattab Osama, Tanas Yousef, Hafez Wael PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider IVL as a potentially safer alternative to rotational atherectomy for calcified coronary lesions due to lower mortality.

This meta-analysis evaluated the clinical and procedural outcomes of intravascular lithotripsy (IVL) versus rotational atherectomy (RA) in 1247 patients with calcified coronary lesions undergoing percutaneous coronary intervention. The analysis synthesized data from both randomized and cohort studies to compare these two calcium modification techniques.

The primary findings indicate that IVL is associated with a lower risk of mortality (RR=0.51; 95% CI, 0.28-0.93; p=0.03) and reduced major adverse cardiovascular events (MACE) (RR=0.43; 95% CI, 0.19-0.98; p=0.05) compared to RA. Additionally, a lower incidence of slow reflow was observed with IVL (RR=0.27; 95% CI, 0.11-0.65; p=0.004). No significant differences were found between the two methods regarding myocardial infarction, stroke, dissection, coronary perforation, stent thrombosis, revascularization, lumen area gain, or procedure time.

A limitation noted by the authors was that significance for post-dilation balloon size lumen gain was lost following a sensitivity analysis. Clinical evidence suggests IVL may offer favorable safety and efficacy outcomes over RA for treating calcified lesions. However, because the data includes both randomized and cohort studies, results should be interpreted as associations rather than definitive causal links.

How this fits prior evidence

This meta-analysis addresses a gap in comparing specific calcium modification techniques for coronary artery disease. While previous evidence noted that in-hospital mortality rates for coronary artery disease patients following PCI remain within international benchmarks, this study specifically compares IVL to RA, finding a lower risk of mortality (RR=0.51) and MACE (RR=0.43) with the use of IVL.

When doctors treat blocked heart arteries, they often face the challenge of heavy calcium buildup. This makes it harder for blood to flow through. A large review of data from 1,247 patients compared two ways to clear these blockages: a technique using sound waves called intravascular lithotripsy (IVL) and a method called rotational atherectomy (RA).

The findings suggest that the sound wave method (IVL) performed better in several key areas. Specifically, patients treated with IVL had a lower risk of death and fewer major heart problems like strokes or heart attacks compared to those who received the other treatment. The study also found that IVL led to less slow blood flow immediately after the procedure.

While both methods were effective at opening the artery, the sound wave approach showed a stronger safety profile for serious complications. However, it is important to note that some specific measurements of how much the artery opened during certain parts of the procedure were not significantly different between the two groups. Because this was a review of existing data, doctors should still consider each patient's unique needs when choosing a treatment.

What this means for you:

Sound wave technology may offer better safety and fewer serious complications for treating hardened heart arteries.

Common questions

What is intravascular lithotripsy?

Intravascular lithotripsy (IVL) is a procedure that uses sound waves to break up hard calcium deposits in the arteries. This helps doctors open blocked vessels more effectively when traditional methods might struggle with heavy calcification.

How does it compare to rotational atherectomy?

In this study of 1,247 patients, IVL showed a lower risk of death and fewer major adverse cardiovascular events compared to rotational atherectomy. It also resulted in less slow blood flow during the procedure.

Are there any risks involved with this treatment?

While IVL showed better safety outcomes than the comparison method, doctors still monitor for complications like coronary perforation or stent thrombosis. You should talk to your doctor about which technique is best for your specific heart condition.

Study Details

Study typeMeta analysis

Sample sizen = 1,247

EvidenceLevel 1

PublishedJul 2026

PMID42013230

View Original Abstract ↓

BACKGROUND: Coronary calcification poses a significant challenge during percutaneous coronary intervention (PCI) with intravascular lithotripsy (IVL) and rotational atherectomy (RA), which are common plaque-modifying strategies. AIMS: This meta-analysis aimed to compare the clinical and procedural outcomes of IVL and RA in patients with calcified coronary lesions. METHODS: Following PRISMA and Cochrane guidelines, PubMed, Scopus, and Web of Science were searched through January 4, 2025, for randomized and cohort studies comparing IVL and RA in patients with coronary calcification. Outcomes included mortality, myocardial infarction (MI), stroke, major adverse cardiovascular events (MACE), dissection, slow reflow, coronary perforation, stent thrombosis, revascularization, minimal stent area, lumen area gain, procedure time, and post-dilation balloon size lumen gain. Pooled estimates are reported as risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Twelve studies comprising 1247 patients (612 with IVL and 635 with RA) were included. IVL was associated with a significantly lower mortality risk (RR = 0.51; 95% CI, 0.28-0.93; p = 0.03), reduced MACE (RR = 0.43; 95% CI, 0.19-0.98; p = 0.05), and lower incidence of slow reflow (RR = 0.27; 95% CI, 0.11-0.65; p = 0.004). No significant differences were found in MI, stroke, dissection, perforation, stent thrombosis, revascularization, or procedural parameters including lumen area gain and procedure time. Although post-dilation balloon size lumen gain initially favored IVL, the significance was lost after the sensitivity analysis. CONCLUSION: IVL demonstrates favorable safety and efficacy outcomes compared with RA, with lower rates of mortality, MACE, and slow reflow. These findings support the role of IVL in the treatment of calcified coronary lesions.

Intravascular lithotripsy reduces mortality risk and MACE in calcified coronary lesions compared to rotational atherectomyIntravascular lithotripsy shows better safety for calcified heart lesions

How this fits prior evidence

Common questions

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