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Intravascular Lithotripsy Is Associated With Superior Clinical Outcomes Compared to Atherectomy: A Large‐Scale, Propensity‐Matched Analysis

Year: 2026

Type: article

Abstract: BACKGROUND: Coronary artery disease (CAD) with severe calcification remains a growing challenge in percutaneous coronary intervention (PCI). Atherectomy (ATH) has long been used for plaque modification, whereas intravascular lithotripsy (IVL) has emerged as a promising alternative. Large-scale comparative data on long-term outcomes are limited. AIMS: To compare 1-year clinical outcomes, 30-day procedural complications, and temporal trends between IVL and ATH use. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, analyzing de-identified data from 47 health care organizations. Adults with CAD undergoing single-vessel PCI with drug-eluting stent (DES) and either IVL or ATH were included. Outcomes were assessed after propensity matching, and annual utilization trends were evaluated from 2013 to 2024. RESULTS: We identified 13,499 patients who underwent DES with IVL (n = 7026) or ATH (n = 6473). After matching, 5768 patients remained in each cohort. At 1 year, IVL was associated with lower risk of all-cause mortality (RR 0.64; 95% CI 0.58-0.72; p < 0.0001), myocardial infarction (RR 0.80; 95% CI 0.66-0.96; p = 0.0166), and MACE (RR 0.71; 95% CI 0.62-0.82; p < 0.0001). IVL also reduced 30-day procedural complications (RR 0.77; 95% CI 0.61-0.97; p = 0.0271), with less bleeding (RR 0.44; 95% CI 0.31-0.62; p < 0.0001) and CA-AKI (RR 0.71; 95% CI 0.55-0.91; p = 0.0068). IVL use increased rapidly and surpassed ATH after 2022. CONCLUSION: In this large, real-world registry, IVL was associated with more favorable 1-year outcomes and fewer 30-day complications than ATH. These findings support IVL as a safe and effective alternative for complex coronary lesions, emphasizing the need for validation in randomized trials to assess for causality.

Source: Catheterization and Cardiovascular Interventions

DOI: 10.1002/ccd.70464

Authors: Charles D. Miks, Grant K. Ozaki, Chirayu R. Shukla, Vikram Sharma

Institution: University of Iowa Health Care

Language: English

Topic: Coronary Interventions and Diagnostics

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,490