Intravascular Lithotripsy versus Rotational Atherectomy in Coronary Chronic Total Occlusions: Analysis from the PROGRESS-CTO registry.

BACKGROUND

There is limited comparative data on the use of plaque modification devices during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

METHODS

We compared intravascular lithotripsy (IVL) with rotational atherectomy (RA) for lesion preparation in patients who underwent CTO PCI across 50 US and non-US centers from 2019 to 2024.

RESULTS

Among 15,690 patients who underwent CTO PCI during the study period, 436 (2.78%) underwent IVL and 381 (2.45%) RA. Patients treated with IVL had more comorbidities and more complex CTO lesions. Antegrade wiring was the most commonly used initial and successful crossing strategy for lesions treated with both IVL and RA, although the retrograde approach was more frequently employed in IVL cases. Procedure and fluoroscopy times, as well as air kerma radiation doses and contrast volumes, were higher in patients treated with RA compared with IVL. There were no significant differences between the groups in technical success (97.2% vs. 95.3%, p=0.20), procedural success (94.7% vs. 91.8%, p=0.14), and in-hospital major adverse cardiac events (MACE) (3.0 % vs. 4.2%, p=0.47). However, coronary perforations were more frequent in patients undergoing RA (9.5% vs. 3.2%, p<0.001). Multivariable logistic regression analysis revealed that IVL compared with RA was not independently associated with technical success, procedural success, or in-hospital MACE.

CONCLUSIONS

In patients undergoing CTO PCI, IVL is associated with similar in-hospital MACE, technical success, and procedural success, but lower incidence of coronary perforation, compared with RA.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Brilakis reports administrative support was provided by Minneapolis Heart Institute Foundation. Brilakis reports a relationship with Abbott Vascular Inc that includes: consulting or advisory. Jaffer reports a relationship with Shockwave Medical Inc that includes: funding grants. Azzalini reports a relationship with Shockwave Medical Inc that includes: consulting or advisory. Dr. Jaffer: –sponsored research: Canon, Siemens, Shockwave, Teleflex, Boston Scientific, HeartFlow, Neovasc; consultant/speakers fees: Magenta Medical, Philips, Biotronik, Mercator, Terumo, Abiomed, Shockwave, DurVena, Intravascular Imaging Inc., Medtronic, FastWave; Equity interest: Intravascular Imaging Inc, DurVena, FastWave. Massachusetts General Hospital – licensing arrangements: Terumo, Canon, SpectraWAVE, for which FAJ has the right to receive royalties. Dr. Azzalini received consulting fees from Teleflex, Abiomed, GE Healthcare, Reflow Medical, Shockwave, and Cardiovascular Systems, Inc.; received a research grant by Abiomed; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical. Dr. Davies: speaking honoraria from Abiomed, Asahi Intec, Boston Sci, Medtronic, Shockwave and Teleflex. Also serves on advisory boards for Abiomed, Avinger, Boston Sci, Medtronic, Rampart and Shockwave. Dr. Sandoval: consulting/speaker honoraria from Abbott Diagnostics, Roche Diagnostics, Zoll, Philips. JACC Advances associate editor. Patent 20210401347. Dr. Brilakis: consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, IMDS, Medtronic, and Teleflex; research support: Boston Scientific, GE Healthcare; owner, Hippocrates LLC; shareholder: MHI Ventures, Cleerly Health, Stallion Medical. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.