{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:43:35Z","timestamp":1780447415903,"version":"3.54.1"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe coronary artery calcification (CAC) remains a significant challenge in interventional cardiology, especially in elderly and comorbid patients, such as diabetes or chronic kidney disease. CAC often leads to complications such as stent thrombosis and restenosis, therefore leading to bad clinical outcomes and increased major adverse cardiovascular events (MACE) rates. Traditional approaches, including rotational atherectomy (RA), are commonly used to treat calcified plaques; however, are limited by procedural complexity, length of procedures, and risk of vascular injury. In contrast, intravascular lithotripsy (IVL) has emerged as a novel therapy using acoustic pressure waves to break calcified plaques with minimal vascular trauma. Despite its increasing use, direct comparisons between IVD and RA in the context of severe CAC are scant and leave critical evidence gaps for therapy optimization. This study compares IVL and RA outcomes to improve strategies for severe CAC management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims at comparing the clinical outcomes such as procedural success, safety evaluations and clinical efficacy of IVL with RA in the treatment of severe CAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta\u2010analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD42024626551). Searches were performed in PubMed, ScienceDirect, Embase, and Scopus databases using the descriptors \u201cRotablator,\u201d \u201cLithotripsy,\u201d and \u201cCoronary Disease\u201d combined with Boolean operators (\u201cAND\u201d and \u201cOR\u201d). Eligible studies directly compared IVL and RA, assessing outcomes such as procedural success, safety, and efficacy. Inclusion criteria were directed to retrospective cohorts and randomized studies with at least 6 months of follow\u2010up, excluding case reports, reviews, and conference abstracts. Two independent reviewers performed data extraction with a third resolving discrepancies. The ROBINS\u2010I tool was used to assess the risk of bias in non\u2010randomized studies, while statistical analyses were done using R software (version 4.3.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies with a total of 2120 patients were included. IVL demonstrated significant benefits over RA, such as reduced use of contrast (MD: \u221217.45\u2009mL; 95% CI: \u221232.79 to \u22122.11) and lower procedural time (MD: \u221227.90\u2009min; 95% CI: \u221230.11 to \u221225.68;\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2 = 92.3%). IVL also effectively treated complex lesions, such as bifurcations and calcified left main arteries, by fragmenting plaques with minimal vascular trauma and reduced procedural risks. While luminal gain showed no differences between groups (MD: \u22120.07\u2009mm\u00b2; 95% CI: \u22120.34 to 0.35), IVL provided higher rates of stent deployment success and lower target lesion revascularization, indicating better long\u2010term vessel patency. The meta\u2010analysis for mortality outcome showed a pooled OR of 0.55 (95% CI: 0.28\u20131.06;\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2 = 1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42) under the common\u2010effect model and 0.70 (95% CI: 0.35\u20131.42) under the random\u2010effects model, with negligible heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2 = 1%). These consistent findings across studies reinforce IVL as a safer and effective strategy for severe CAC and warrant further trials to establish long\u2010term benefits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IVL showed slight advantages over RA in severe CAC, including reduced contrast use, shorter procedure times, and fewer complications. Further trials are needed to confirm these findings and to reduce the heterogeneity of the studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccd.31591","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T02:14:42Z","timestamp":1747102482000},"page":"563-572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intravascular Lithotripsy Versus Rotational Atherectomy for Calcified Coronary Lesions: A Systematic Review and an Updated Meta\u2010Analysis of Clinical Outcomes"],"prefix":"10.1002","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6252-6708","authenticated-orcid":false,"given":"Ricardo Fonseca Oliveira","family":"Suruagy\u2010Motta","sequence":"first","affiliation":[{"name":"Department of Medicine Cesmac University Center Macei\u00f3 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3632-4806","authenticated-orcid":false,"given":"Lucas Silva","family":"Cabe\u00e7a","sequence":"additional","affiliation":[{"name":"Department of Medicine Federal University of Par\u00e1 Bel\u00e9m Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4789-6019","authenticated-orcid":false,"given":"Anderson Matheus Pereira","family":"Da Silva","sequence":"additional","affiliation":[{"name":"Department of Pharmacology Federal University of the S\u00e3o Francisco Valley Petrolina Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5901-9935","authenticated-orcid":false,"given":"Gabriel Rezende","family":"Neves","sequence":"additional","affiliation":[{"name":"Department of Medicine State University of Par\u00e1 Bel\u00e9m Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4487-1807","authenticated-orcid":false,"given":"Maria Tereza","family":"Camarotti","sequence":"additional","affiliation":[{"name":"Department of Medicine Pernambuco's Health College Recife Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2019-4589","authenticated-orcid":false,"given":"Luan Cavalcante Vila\u00e7a","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Medicine Federal University of Rio de Janeiro Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane Barros Mesquita","family":"Cunha","sequence":"additional","affiliation":[{"name":"Department of Medicine Federal University of Rio de Janeiro Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8734-3802","authenticated-orcid":false,"given":"Edmundo Damiani","family":"Bertoli","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Marieta Konder Bornhausen Hospital Itaja\u00ed Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0849-5435","authenticated-orcid":false,"given":"Laila Leite Pacheco","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Medicine Cesmac University Center Macei\u00f3 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5153-6583","authenticated-orcid":false,"given":"Thiago Jos\u00e9 Matos","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Medicine Cesmac University Center Macei\u00f3 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6953-8544","authenticated-orcid":false,"given":"Marcos Danillo","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Escola Paulista de Medicina\u2014EPM\/UNIFESP S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2017.10.012"},{"key":"e_1_2_9_3_1","unstructured":"World Health Statistics 2018: Monitoring Health for the SDGs Sustainable Development Goals [Internet] accessed January 6 2025 https:\/\/www.who.int\/publications\/i\/item\/9789241565585."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00596-8"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2019-300117"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.20517\/2574-1209.2023.26"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab484"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.31140"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2021.06.132"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n160"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7647"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-7-16"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000368959.11129.79"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.4070\/kcj.2021.0155"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.02.028"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30815"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2024.05.030"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2024.10.018"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.07.174"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2022.10.011"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19159011"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-5683.21.05681-7"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30855"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-024-03965-1"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30519"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.29263"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.07.023"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26587"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25945"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11071779"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carrev.2022.06.261"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.03.038"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31591","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccd.31591","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.31591","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:08:11Z","timestamp":1771222091000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.31591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/ccd.31591"],"URL":"https:\/\/doi.org\/10.1002\/ccd.31591","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"value":"1522-1946","type":"print"},{"value":"1522-726X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]},"assertion":[{"value":"2025-04-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}