Rather than a binary choice—atherectomy or lithotripsy—the market for treating severely calcified lesions seems likely to evolve into a mixture of both technologies. That, in fact, is already occurring. One strategy gaining currency among interventionalists, particularly those in Europe, is to try a high-pressure balloon first in cases of moderately severe calcification and, if the device fails to fully expand, re-enter the vessel with atherectomy. 

Throughout its nearly 30-year history, atherectomy has remained something of an under-achiever. Witness a 2020 study in Circulation: Cardiovascular Interventions, where Ajay Kirtane, MD, SM, of Columbia University Medical Center, and co-authors found that adjunctive coronary atherectomy was performed in just 3 percent of the nearly four million cases drawn from the CathPCI Registry in the fourth quarter of 2016, up from 1.1 percent in the third quarter of 2009. 

Can a disruptive technology from the past become the nemesis of calcified lesions in the future?

Rather than a binary choice—atherectomy or lithotripsy—the market for treating severely calcified lesions seems likely to evolve into a mixture of both technologies. 

Throughout its nearly 30-year history, atherectomy has remained something of an under-achiever.

Can a disruptive technology from the past become the nemesis of calcified lesions in the future?

The aging population plus increases in hypertension, diabetes and chronic kidney disease have contributed to more patients having severely calcified arterial lesions.

As the coronavirus resurges and mutates, healthcare leaders are striving not just to contain infection but also to avoid a repeat of the financial devastation many hospitals suffered in 2020 when their facilities closed to nonemergent care.