{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:12:37Z","timestamp":1778224357401,"version":"3.51.4"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JRSM Cardiovascular Disease"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe coronary calcification can impede stent delivery and affect long-term outcomes. Few trials have compared coronary atherectomy with balloon-first strategies for lesion preparation before drug-eluting stent (DES) implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched MEDLINE, Embase, and the Cochrane Library through October 2025 for randomized controlled trials (RCTs) comparing coronary atherectomy with balloon angioplasty for lesion preparation before DES implantation in severely calcified coronary lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across three RCTs, there was no significant difference in major adverse cardiovascular events between atherectomy and balloon angioplasty (risk ratio [RR] 1.05, 95% confidence interval [CI] 0.85\u20131.30;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Strategy success trended higher with atherectomy but did not reach statistical significance (RR 1.10, 95% CI 0.99\u20131.23;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200984%). No significant differences were observed for myocardial infarction (RR 1.06, 95% CI 0.80\u20131.42;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), any revascularization (RR 0.68, 95% CI 0.25\u20131.82;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200983%), target lesion revascularization (RR 0.88, 95% CI 0.57\u20131.37;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200983%), target vessel revascularization (RR 0.89, 95% CI 0.64\u20131.24;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), stent thrombosis (RR 2.75, 95% CI 0.94\u20138.06;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), cardiac mortality (RR 1.49, 95% CI 0.93\u20132.40;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), all-cause mortality (RR 1.10, 95% CI 0.79\u20131.54;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), or procedural complications (RR 0.95, 95% CI 0.69\u20131.30;\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20093%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our meta-analysis showed that routine atherectomy was comparable with balloon angioplasty in severely calcified coronary lesions. These findings support a selective, imaging-guided balloon-first strategy, reserving atherectomy for lesions that remain undilatable or uncrossable. Randomized studies of imaging-guided algorithms and emerging technologies are needed to define optimal lesion-specific strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20480040261446478","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:47:41Z","timestamp":1778222861000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary atherectomy versus balloon angioplasty before drug-eluting stent implantation in severely calcified lesions: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"15","author":[{"given":"Omar","family":"Kasimieh","sequence":"first","affiliation":[{"name":"University of the East Ramon Magsaysay Memorial Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yashaswi","family":"Guntupalli","sequence":"additional","affiliation":[{"name":"Sri Venkateswara Institute of Medical Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prapti Atul","family":"Patel","sequence":"additional","affiliation":[{"name":"GMERS Medical College and Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia Susan","family":"Abraham","sequence":"additional","affiliation":[{"name":"Aneurin Bevan Health Board"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas Viji","family":"Pulickal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md Arif Hasan","family":"Bhuiyan","sequence":"additional","affiliation":[{"name":"Croydon University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milikyas Abera","family":"Feyisa","sequence":"additional","affiliation":[{"name":"Naas General Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Bushnaq","sequence":"additional","affiliation":[{"name":"Jordan University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4967-6544","authenticated-orcid":false,"given":"Rohit Mote","family":"Reddy","sequence":"additional","affiliation":[{"name":"Bhaskar Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiva","family":"Mokhtassi","sequence":"additional","affiliation":[{"name":"St George's Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arooba","family":"Ejaz","sequence":"additional","affiliation":[{"name":"Dow Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8092-7072","authenticated-orcid":false,"given":"Asma\u2019a Munasar","family":"Ali Alsubari","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Sana\u2019a University, Sana\u2019a, Yemen"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaibhav","family":"Vats","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talal","family":"Almas","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland medical Centre, Case Western Reserve University, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huzaifa Ahmad","family":"Cheema","sequence":"additional","affiliation":[{"name":"King Edward Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"22","article-title":"Percutaneous coronary intervention of moderate to severe calcified coronary lesions: insights from the National Heart, Lung and Blood Institute Dynamic Registry","volume":"77","author":"Bangalore S","year":"2011","unstructured":"Bangalore S, Vlachos HA, Selzer F, et al. 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SCAI expert consensus statement on management of in-stent restenosis and stent thrombosis. J Soc Cardiovasc Angiogr Interv 2023; 2: 100971.","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.11.012"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12196254"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X18666211228095457"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-025-01083-5"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/joic.12491"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-023-03673-2"},{"key":"e_1_3_2_15_2","first-page":"2","article-title":"Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion","volume":"97","author":"Neupane S","year":"2021","unstructured":"Neupane S, Basir M, Tan C, et al. Feasibility and safety of orbital atherectomy for the treatment of in-stent restenosis secondary to stent under-expansion. Catheter Cardiovasc Interv 2021; 97: 2\u20137.","journal-title":"Catheter Cardiovasc Interv"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.118.007415"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.07.017"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)00450-7"},{"key":"e_1_3_2_19_2","doi-asserted-by":"crossref","unstructured":"Page MJ McKenzie JE Bossuyt PM et al. 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