{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:33:52Z","timestamp":1781008432794,"version":"3.54.1"},"reference-count":36,"publisher":"Radcliffe Medical Media Ltd","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/legalcode"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Interv Cardiol"],"abstract":"<jats:p>Background: Rotational atherectomy (RA) and intravascular lithotripsy (IVL) are well-established technologies for modification of coronary calcification. Given their contrasting mechanisms of action, there has been interest in whether the use of these devices in conjunction could potentially be synergistic and offer improved procedural results. The aim of this study was therefore to evaluate the efficacy, procedural safety and long-term outcomes of combining RA and IVL, termed \u2018RotaShock\u2019 (RSK), for the treatment of severe coronary calcification. Methods: A single-centre retrospective analysis was carried out of consecutive patients treated with an RSK strategy for coronary calcification from January 2019 until September 2022. Baseline demographics, comorbidity details, details of the percutaneous coronary intervention procedure, angiographic and\/or intracoronary imaging (ICI) results and presence of target vessel revascularisation or mortality were recorded. Results: A total of 36 patients were treated with RSK; the majority of patients were male (n=29; 80.6%) and the median age was 75\u00a0years (IQR 70\u201379\u00a0years). The majority of cases involved treating the left anterior descending artery (63.4%) but one-third involved percutaneous coronary intervention to the left main coronary artery. The vast majority of cases were guided by ICI (88.9%) and were performed through radial access (80.6%). In patients with ICI available for analysis, the median minimum stent area was 7.7\u00a0mm2 (IQR 6.2\u201310.0\u00a0mm2). There were two access site complications but no other periprocedural complications. The median follow-up was 942\u00a0days (IQR 645\u20131,306\u00a0days). Despite the high complexity of lesions treated, follow-up identified only two cases of target vessel revascularisation. There were five cases of non-adjudicated all-cause mortality. Conclusion: RSK is an effective and safe strategy for modification of severe coronary calcification, with long-term results suggesting a highly durable result. Further and randomised data are now mandated to evaluate the relative merits of RSK compared with RA or IVL alone.<\/jats:p>","DOI":"10.15420\/icr.2024.34","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T11:02:39Z","timestamp":1741690959000},"source":"Crossref","is-referenced-by-count":6,"title":["\u2018RotaShock\u2019 \u2013 A Revolution in Calcium Modification: Long\u2011term Follow-up from a Single High-volume Centre"],"prefix":"10.15420","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1670-5550","authenticated-orcid":false,"given":"Jonathan","family":"Hinton","sequence":"first","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Varma","sequence":"additional","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehangir","family":"Din","sequence":"additional","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Kodoth","sequence":"additional","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suneel","family":"Talwar","sequence":"additional","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-4547","authenticated-orcid":false,"given":"Peter","family":"O\u2019Kane","sequence":"additional","affiliation":[{"name":"Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Guedeney P, Claessen BE, Mehran R, et al. Coronary calcification and long-term outcomes according to drug-eluting stent generation. JACC Cardiovasc Interv 2020;13:1417\u201328. https:\/\/doi.org\/10.1016\/j.jcin.2020.03.053; PMID:\u00a032553329.","DOI":"10.1016\/j.jcin.2020.03.053"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Tada T, Miura K, Ikuta A, et al. Prevalence, predictors, and outcomes of in-stent restenosis with calcified nodules. EuroIntervention 2022;17:1352\u201361. https:\/\/doi.org\/10.4244\/EIJ-D-21-00504; PMID:\u00a034483090.","DOI":"10.4244\/eij-d-21-00504"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Choi SY, Maehara A, Cristea E, et al. Usefulness of minimum stent cross sectional area as a predictor of angiographic restenosis after primary percutaneous coronary intervention in acute myocardial infarction (from the HORIZONS-AMI Trial IVUS substudy). Am J Cardiol 2012;109:455\u201360. https:\/\/doi.org\/10.1016\/j.amjcard.2011.10.005; PMID:\u00a022118823.","DOI":"10.1016\/j.amjcard.2011.10.005"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Kawashima H, Serruys PW, Hara H, et al. 10-year all-cause mortality following percutaneous or surgical revascularization in patients with heavy calcification. JACC Cardiovasc Interv 2022;15:193\u2013204. https:\/\/doi.org\/10.1016\/j.jcin.2021.10.026; PMID:\u00a034973904.","DOI":"10.1016\/j.jcin.2021.10.026"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Copeland-Halperin RS, Baber U, Aquino M, et al. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: findings from a large multiethnic registry. 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Comparison of coronary intravascular lithotripsy and rotational atherectomy in the modification of severely calcified stenoses. Am J Cardiol 2023;197:93\u2013100. https:\/\/doi.org\/10.1016\/j.amjcard.2023.02.028; PMID:\u00a037012181.","DOI":"10.1016\/j.amjcard.2023.02.028"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Hill JM, Kereiakes DJ, Shlofmitz RA, et al. Intravascular lithotripsy for treatment of severely calcified coronary artery disease. J Am Coll Cardiol 2020;76:2635\u201346. https:\/\/doi.org\/10.1016\/j.jacc.2020.09.603; PMID:\u00a033069849.","DOI":"10.1016\/j.jacc.2020.09.603"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Ali ZA, Nef H, Escaned J, et al. Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses: the disrupt CAD II study. Circ Cardiovasc Interv 2019;12:e008434. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.119.008434; PMID:\u00a031553205.","DOI":"10.1161\/circinterventions.119.008434"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Brinton TJ, Ali ZA, Hill JM, et al. Feasibility of Shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses. Circulation 2019;139:834\u20136. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.118.036531; PMID:\u00a030715944.","DOI":"10.1161\/circulationaha.118.036531"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Saito S, Yamazaki S, Takahashi A, et al. Intravascular lithotripsy for vessel preparation in severely calcified coronary arteries prior to stent placement: primary outcomes from the Japanese Disrupt CAD IV study. 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Coronary lithotripsy as elective or bail-out strategy after rotational atherectomy in the rota-shock registry. Am J Cardiol 2023;198:1\u20138. https:\/\/doi.org\/10.1016\/j.amjcard.2023.04.032; PMID:\u00a037182254.","DOI":"10.1016\/j.amjcard.2023.04.032"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Ielasi A, Loffi M, De Blasio G, Tespili M. \u2018Rota-Tripsy\u2019: a successful combined approach for the treatment of a long and heavily calcified coronary lesion. Cardiovasc Revasc Med 2020;21:152\u20134. https:\/\/doi.org\/10.1016\/j.carrev.2019.12.023; PMID:\u00a031883981.","DOI":"10.1016\/j.carrev.2019.12.023"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Briosa A, Pereira AR, Martinho M, et al. Impella-rota-shock percutaneous coronary intervention: three weapons, one last remaining vessel. 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Combined use of rotational and excimer lASER coronary atherectomy (RASER) during complex coronary angioplasty: an analysis of cases (2006\u20132016) from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv 2021;97:E911\u201318. https:\/\/doi.org\/10.1002\/ccd.29377; PMID:\u00a033201601.","DOI":"10.1002\/ccd.29377"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Allali A, Toelg R, Abdel-Wahab M, et al. Combined rotational atherectomy and cutting balloon angioplasty prior to drug-eluting stent implantation in severely calcified coronary lesions: the PREPARE-CALC-COMBO study. Catheter Cardiovasc Interv 2022;100:979\u201389. https:\/\/doi.org\/10.1002\/ccd.30423; PMID:\u00a036262074.","DOI":"10.1002\/ccd.30423"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Saito S, Yamazaki S, Takahashi A, et al. Intravascular lithotripsy for vessel preparation in calcified coronary arteries prior to stent placement: Japanese Disrupt CAD IV study 1-year results. Circ Rep 2022;4:399\u2013404. https:\/\/doi.org\/10.1253\/circrep.CR-22-0068; PMID:\u00a036120480.","DOI":"10.1253\/circrep.cr-22-0068"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Kereiakes DJ, Hill JM, Shlofmitz RA, et al. Intravascular lithotripsy for treatment of severely calcified coronary arteries: 2-year results \u2013 Disrupt CAD III study. JACC Cardiovasc Interv 2023;16:2472\u20134. https:\/\/doi.org\/10.1016\/j.jcin.2023.07.010; PMID:\u00a037676225.","DOI":"10.1016\/j.jcin.2023.07.010"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Hinton J, O\u2019Kane P. Combination tools for calcium modification from RASER to Orbitalshock. Interv Cardiol 2024;19:e18. https:\/\/doi.org\/10.15420\/icr.2024.24; PMID:\u00a039449725.","DOI":"10.15420\/icr.2024.24"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Dall\u2019Ara G, Alagna G, Spart\u00e0 D, et al. Sheathless radial approach in contemporary coronary rotational atherectomy: data from two high-volume centers. Vessel Plus 2023;7:26. https:\/\/doi.org\/10.20517\/2574-1209.2023.107.","DOI":"10.20517\/2574-1209.2023.107"},{"key":"ref33","unstructured":"Honton B. French National France LILI registry on all comers\u2019 patients treated by IVL PCR online: Europa Group. 2023. https:\/\/www.pcronline.com\/Cases-resources-images\/Resources\/Course-videos-slides\/2023\/EuroPCR\/High-risk-PCI-in-cardiogenic-shock-and-calcified-vessels (accessed 25 July 2024)."},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Fujino A, Mintz GS, Matsumura M, et al. A new optical coherence tomography-based calcium scoring system to predict stent underexpansion. 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