Intravascular Lithotripsy or Mechanical Debulking in Complex Calcified Coronary Arteries: Multicenter, Prospective ROLLING STONE Study
Authors' conclusion
The study confirms the feasibility, safety, and efficacy of IVL and AT in an unselected population, with similar procedural success rates. After propensity matching, IVL seems to demonstrate in our cohort a better 12-month safety outcome.
Study context
- Population
- Real-world all-comer patients with complex calcified coronary arteries, 23 Italian centres81 treated with both excluded
- Participants
- 1,005 patients
- Exposure
- Intravascular lithotripsy (IVL) vs atherectomy
- IVLn = 544
- Atherectomy (AT)n = 380reference
- Outcome
- Procedural success (residual stenosis <30% and no in-hospital MACE: cardiac death, MI, target vessel revascularization); primary safety endpoint freedom from MACE at 30 days
Methodological detailsmulticentre, propensity-score matched, inverse probability weighting
- Multicentre
- Propensity-score matched
- Inverse probability weighting
Main finding
Procedural success
Relative risk
1.01
95% CI 0.88–1.17
By group
IVL vs AT
relative risk 1.01 (95% CI 0.88–1.17)
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | IVL | AT | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| MACE, after propensity score matching and inverse probability weighting · 12 months | 6.8% | 14.3% | 0.43 (0.21–0.89) | P = 0.022 | |
| CV death · 30 days | 1.7% | 3.9% | 0.40 (0.18–0.92) | P = 0.030 | |
| 0.20.5125Hazard ratio (log scale) |
- Major adverse cardiac events (MACE), after propensity score matching and inverse probability weighting: propensity score matching (n = 320) and inverse probability weighting (n = 532)
Safety
| Outcome | IVL | AT | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| MACE (primary safety endpoint) · 30 days | 5.7% | 8.6% | 0.60 (0.36–0.99) | P = 0.045 | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Intravascular Lithotripsy or Mechanical Debulking in Complex Calcified Coronary Arteries: Multicenter, Prospective ROLLING STONE Study. JACC Cardiovasc Interv. Published 29 January 2026. doi:10.
Summarised from the published abstract; every number is checked against it