Why is this study important?

• Calcified coronary lesions are increasingly encountered during percutaneous coronary intervention (PCI) and are associated with worse major adverse cardiovascular outcomes.
• Randomized controlled data comparing different strategies is limited.

What question was this study supposed to answer?

• To compare the efficacy and safety of super high-pressure OPN-noncompliant balloon (NCB) and intravascular lithotripsy (IVL). Stent expansion was assessed by optical coherence tomography (OCT).

 What did the study show?

• 282 patients with angiographically significant stenosis and severe calcification (assessed by angiography and/or OCT) were randomized to either OPN NCB or intravascular lithotripsy (IVL) with follow-up of 30 days.
• Lesion preparation was performed with either OPN NCB or IVL, followed by everolimus- or zotarolimus-eluting stents. Post-PCI OCT was performed. Clinical follow-up was performed at 30 days.
• There was no significant difference in the primary outcome of stent expansion between OPN NCB and IVL. Either strategy resulted in similar procedure success.
• There was no significant difference in safety outcomes, including coronary perforations, between OPN NCB and IVL arms.
• At 30-day follow-up, there was no significant difference in outcomes such as myocardial infarction (MI), repeat revascularizations, or stent thrombosis.

Key insight

• In the VICTORY study, PCI of severely calcified coronary lesions using either OPN NCB or IVL resulted in similar stent expansion.
• Safety profile was acceptable and similar in both arms.