Physiological and angiographic outcomes of PCI in calcified lesions after rotational atherectomy or intravascular lithotripsy

Abstract Background Percutaneous coronary interventions (PCI) in calcified artery lesions is associated with impaired stent expansion, higher rate of periprocedural complications and cardiac mortality. Lesion preparation using dedicated calcium modifying techniques such as RA or IVL has been advocated. Studies comparing these technologies are lacking. Objectives To compare the in-stent pressure gradient, evaluated by virtual fractional flow-reserve, calcific treated either rotational atherectomy (RA) intravascular lithotripsy (IVL). Methods Patients undergoing RA- IVL-assisted PCI from two European centers were included. Propensity score matching (1:2) was performed to control for potential bias. Primary outcome post- gradient calculated flow reserve (vFFRgrad, difference between vFFR at proximal minus distal edge stent). Secondary outcomes included proportion patients complete functional revascularization defined post (vFFRpost) ≥0.90. Results From a cohort 210 patients, 105 matched (70 35 IVL) Pre-PCI did not differ groups (0,65±0,13 0,67±0,11 IVL). After PCI, significantly lower group (0.032±0.026 vs 0.043±0.026 group, p=0.024). The vessels similar (32.9% vs. 37.1% respectively; p=0.669) Conclusions Calcific effective resulted improved compared RA. Approximately one third severely lesion achieved no IVL. Funding Acknowledgement Type funding sources: None. In gradients after