Treatment Procedures for Calcified Coronary Artery Lesions: A Juxtaposing Review of Intravascular Lithotripsy and Rotational Atherectomy

Abstract

The calcium content in the coronary artery is one of the most important factors that influence coronary events. High calcium levels lead to excessive calcification in coronary vessels and are more difficult to treat with percutaneous intervention (PCI). Treatment for complex lesions is performed by intravascular lithotripsy (IVL) system consisting of balloon catheters within which electrical energy is being transformed into mechanical energy. IVL technology discharges soundwaves that transmit to the neighbouring tissue leading to improvement in vascular compliance and the destruction of both superficial and visceral calcium deposits. Consequently, coronary artery calcification (CAC) treatment becomes more effective, more practical, and plays a role in reducing lesion complexity. Types of lesions studied for the IVL system comprise of calcified coronary arteries and peripheral vascular lesions. This article evaluates the role of the IVL system in treating coronary arteries calcification, its benefits, and drawbacks compared to other techniques. According to clinical trials in intravascular lithotripsy and rotational atherectomy, the former was deemed more secure, primarily by reducing the risk of embolization by atheroma. Interpreting the studies included in this review, IVL appears to have superior results in acute lumen gain, success rate, and improvement in stenosis residue, while rotational atherectomy (RA) delivers lesser in-hospital major adverse cardiovascular events (MACE) and provides better approach in the presence of lesion crossings. Additional extensive researches and clinical data are needed to substantiate the efficiency and safety of IVL technology.