ArticleCardiovascular intervention and therapeutics2026
Physiological assessment of coronary microvascular dysfunction and short-term outcomes in severely calcified coronary lesions: a comparison between rotational atherectomy and intravascular lithotripsy.
Article in Cardiovascular intervention and therapeutics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Coronary artery calcification (CAC), one of the greatest challenges of percutaneous coronary intervention (PCI), is associated with a poor prognosis. We therefore conducted a wire-derived physiological evaluation to investigate the influence of CAC modification using intravascular lithotripsy (IVL) and rotational atherectomy (RA) on the coronary circulation. A total of 154 patients with CAC requiring IVL or RA were enrolled in this single-center, retrospective study. Physiological assessments, particularly Index of microcirculatory resistance (IMR), coronary flow reserve (CFR), resistive reserve ratio (RRR), and microvascular resistance reserve (MRR) were performed using a temperature-sensor guidewire (Pressure Wire X, Abbott) pre- and post-PCI and compared between IVL and RA. Procedural and 30-day clinical outcomes were also evaluated. Seventy patients were treated with IVL and 84 with RA. IVL and RA demonstrated comparable lumen expansion. In the physiological assessments, RA significantly increased post-IMR compared to IVL (17.0 [10.5-32.8] vs.12.0 [9.00-19.0], p = 0.03), which was correlated with severity of periprocedural myocardial Infarction (MI) (Spearman's ρ = 0.40, p = 0.01). Post-CFR, post-RRR, and post-MRR were significantly higher with IVL than RA (3.20 [2.00-4.60] vs. 1.55 [1.20-2.10], p < 0.01, 2.90 [2.10-4.70] vs. 1.60 [1.20-2.42], p < 0.01, 2.77 [2.05-4.54] vs. 1.50 [1.20-2.37], p < 0.01, respectively). Use of RA was associated with post-PCI coronary microvascular dysfunction (OR: 4.77, 95% CI:1.51-17.56). Slow flow phenomenon and procedure-related MI were more frequently observed with RA than IVL (19.1% vs. 4.3%, p < 0.01, 35.7% vs. 7.1%, p < 0.01, respectively). In patients with severely calcified coronary lesions, IVL and RA achieved comparable epicardial results, whereas IVL was associated with more favorable post-procedural microvascular physiological indices than RA. Although RA was associated with increased procedural MI, this was not accompanied by a significant difference in short-term major adverse events. Further studies with large populations and long-term follow-up are warranted to determine the clinical significance of these physiological differences.
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