Patients who undergo imaging-guided percutaneous coronary intervention (PCI) for severely calcified coronary lesions can safely receive cutting balloon angioplasty instead of intravascular lithotripsy (IVL), results from the ShortCUT study show. Additionally, the cutting balloon procedure is significantly less expensive than the IVL procedure in this patient population. Suzanne J. Baron, MD, MSC, from Massachusetts General Hospital and the Baim Institute for Clinical Research, Boston, reported these results during a late-breaking clinical trial session on Sunday at the Transcatheter Cardiovascular Therapeutics (TCT) 2025 conference in San Francisco. Severely calcified arteries create more risks for patients who undergo PCI, including increasing the complexity of the procedure and increasing rates of poor clinical outcomes after the procedure. Roughly 30% of patients underoging PCI have coronary calcium. Data are limited on comparison of balloon specialty devices for modified calcium in these patients. Investigators in the ShortCUT trial compared the safety, efficacy and financial costs of cutting balloon angioplasty versus IVL in patients with severely calcified coronary lesions who underwent PCI. A total of 413 patients with significantly calcified lesions underwent imaging-guided PCI, and 208 had planned rotational atherectomy and 205 had no planned rotational atherectomy. In both the separate planned and no planned groups, patients were further randomized 1:1 to receive a cutting balloon (“rota-cut”) or IVL (“rota-shock”). The post-procedural stent area at the site of maximal calcification, measured by intravascular ultrasound (IVUS) assessment, was the primary endpoint of the study. This endpoint was adjudicated by a core lab. All groups demonstrated similar rates of the post-procedural minimum stent area (MSA) (p for noninferiority=0.007). No between-group differences were seen in stent expansion or calcium fractures, for the total study population and the individual cohorts. At the site of maximum calcification, average stent expansion was similar with IVL (97.7±24.0) or cutting balloon (97.7±25.9) (p=0.99). The differences were seen in the financial costs of the procedures: A $3,632 difference was observed between the cutting balloon and IVL groups, with the cutting balloon procedure being cheaper (p<0.001). Overall, use of cutting balloon is safe and more cost-efficient, compared with IVL, in patients with significantly calcified coronary lesions who undergo PCI. “As part of an imaging-based approach to PCI of significantly calcified coronary lesions, cutting balloon angioplasty is a reasonable strategy when compared with intravascular lithotripsy,” said Dr. Baron in a TCT news release on Sunday. “Not only is utilizing a cutting balloon safe and effective, it is also significantly less costly.” This study was supported by a research grant from Boston Scientific. Image Caption: Suzanne J. Baron, MD, MSC, presents during a press conference Sunday, October 26, at the Transcatheter Cardiovascular Therapeutics (TCT) 2025 conference in San Francisco. Image Credit: Screenshot by Bailey G. Salimes, CRTonline.org.