Nishant Goyal

Western Sydney University,
Australia

Abstract Title: Comparison of Coronary Intravascular Lithotripsy and Cutting Balloon in the Treatment of Severely Calcified Coronary Lesions

Biography:

Nishant Goyal is currently completing his Doctor of Medicine (MD) at Western Sydney University. He has a developing interest in cardiology and clinical research aimed at improving cardiovascular outcomes.

Research Interest:

Background: Coronary artery calcification can impede stent deployment during percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) has emerged as an alternative to conventional balloon-based devices, like cutting balloon (CB), for calcium modification.

Purpose: To compare safety and efficacy of IVL against CB in non-cardiac surgery centre.

Methods: Retrospective analysis of consecutive IVL and CB cases between January 2020 to September 2025 at Campbelltown Hospital, Sydney. Primary effectiveness endpoint was minimum luminal area (MLA) gain, analysed using intracoronary imaging (intravascular ultrasound or optical coherence tomography). Primary safety endpoint was 30-day freedom from major adverse cardiovascular events (MACE).

Results: 130 patients were included: IVL (n=49); CB (n=81). 28.6% (n=14) of IVL cases were crossover from CB due to suboptimal angiographic results. Age, sex, BMI, smoking history, hypercholestrolaemia, hypertension, diabetes mellitus and eGFR were similar across both groups. CB group underwent greater proportion of ACS-related PCI (24.5% in IVL vs 51.9% in CB; p=0.002). One IVL procedure achieved modest success, while a crossover case required rotational atherectomy. Mean final MSA (6.05±2.12mm2 vs 5.85±2.37mm2; p=0.616), mean MLA gain (3.02±1.77mm2 vs 2.56±1.9mm2; p=0.086) and 30-day freedom from MACE (87.8% vs 88.9%) were similar amongst both groups. MACE for IVL cases included 8.2% (n=4) peri-procedural myocardial infarction (MI) and 4.1% (n=2) cardiac death (causes were cardiac arrest of unknown aetiology and cardiogenic shock secondary to inferior STEMI). MACE for CB cases included 8.6% (n=7) peri-procedural MI, 3.7% (n=3) cardiac death (one procedure-related case, caused by bradycardia and hypotension secondary to acute pulmonary oedema and cardiomyopathy), 1.2% (n=1) stroke, 1.2% (n=1) unstable angina and 3.7% (n=3) acute decompensated heart failure. Neither groups required target lesion revascularisation. No statistically significant difference in any adverse outcome amongst both groups.

Conclusions: Although IVL and CB are safe and effective calcium modification techniques, IVL is superior in achieving optimal angiographic results.