Shockwave Lithotripsy vs Rotational Atherectomy: Mechanistic Differences From Optical Coherence Tomography

A 63-year-old man presented with a non-ST segment elevation myocardial infarction. He was referred to our hospital for percutaneous coronary intervention (PCI) with rotational atherectomy (RA) after an attempted PCI that was unsuccessful due to a severely calcified undilatable lesion (Figure 1A). The procedure was performed through the right radial approach with a 7.5 Fr sheathless AR2 guiding catheter. Multiple series for the lesion preparation and predilation were attempted, first using 1.5 mm and then 1.75 mm Rota burr (RotaLink Plus; Boston Scientific) followed by sequential non-compliant balloon dilations with several high-pressure, super-high-pressure, and scoring balloons. All ...