Comparison of interventional treatment options for coronary calcified nodules: A sub-analysis of the ROTA.shock trial.

The optimal treatment for coronary calcified nodules (CNs) is still unclear. The aim of this study was to compare the modification of these lesions by coronary intravascular lithotripsy (IVL) and rotational atherectomy (RA) using optical coherence tomography (OCT). ROTA.shock was a 1:1 randomized, prospective, double-arm multi-center non-inferiority trial that compared the use of IVL and RA with percutaneous coronary intervention (PCI) in severely calcified lesions. In 19 of the patients out of this study CNs were detected by OCT in the target lesion and were treated by either IVL or RA. The mean angle of CNs was significantly larger in final OCT scans than before RA (92 ± 17° vs. 68 ± 7°; p = 0.01) and IVL (89 ± 18° vs. 60 ± 10°; p = 0.03). The CNs were thinner upon final scans than in initial native scans (RA: 17.8 ± 7.8 mm vs. 38.6 ± 13.1 mm; p = 0.02; IVL: 16.5 ± 9.0 mm vs. 37.2 ± 14.3 mm; p = 0.02). Nodule volume did not differ significantly between native and final OCT scans (RA: 0.66 ± 0.12 mm3 vs. 0.61 ± 0.33 mm3; p = 0.68; IVL: 0.64 ± 0.19 mm3 vs. 0.68 ± 0.22 mm3; p = 0.74). Final stent eccentricity was high with 0.62 ± 0.10 after RA and 0.61 ± 0.09 after IVL. RA or IVL are unable to reduce the volume of the calcified plaque. CN modulation seems to be mainly induced by the stent implantation and not by RA or IVL. Effects of PCI using RA or IVL on CNs. PCI: Percutaneous coronary intervention; CN: Calcified nodule; RA: Rotational atherectomy; IVL: Intravascular lithotripsy. [Display omitted] • Rotational atherectomy or intravascular lithotripsy are unable to reduce the volume of the calcified plaque. • Calcified nodule modification seems to be induced by a displacement of the CNs in the course of stent implantation. • Final stent eccentricity is high after PCI of calcified nodules using rotational atherectomy or intravascular lithotripsy. [ABSTRACT FROM AUTHOR]