Intravascular Lithotripsy With or Without Rotational Atherectomy for Coronary Calcified Nodule Treatment

ID#: NCT07000045

Age: 18 years - 66+

Gender: All

Healthy Subjects: No

Study Phase: N/A

Recruitment Status: Recruiting

Start Date: October 06, 2025

End Date: December 31, 2027

Contact Information:
Keisuke Yasumura, MD
(212) 241-4181
Summary: The NODULE-SHOCK trial is a prospective, investigator-initiated, single-center, randomized controlled trial designed to compare the efficacy of intravascular lithotripsy (IVL) with or without rotational atherectomy (RA) in patients with coronary calcified nodules (Cohort A), and operator-determined vs maximum IVL pulses in patients with non-nodular severe coronary calcium (Cohort B).
Eligibility: Inclusion Criteria

- Age ≥18 years who signed written informed consent

- Presence of a clinical indication for coronary intervention

- Patients undergoing PCI for a de novo calcified lesion with planned drug-eluting stent (DES) implantation

- Native coronary artery with significant stenosis defined as:

- ≥70% and <100% stenosis on angiography, or

- 50-70% stenosis with evidence of ischemia (positive stress test, FFR ≤ 0.8, or OCT minimal lumen area (MLA) ≤ 4.0 mm2)

- Reference vessel diameter: ≥2.5 mm to ≤ 4.0 mm

- Lesion length: ≥5mm

- Moderate to severe calcification of the target lesion confirmed by angiography

- Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 at baseline Exclusion Criteria

- Cardiogenic shock at the time of procedure

- Primary PCI for ST-segment elevation myocardial infarction (STEMI)

- Pregnant, nursing, or childbearing potential without adequate contraception

- Known allergy or contraindication to DAPT (aspirin, clopidogrel, prasugrel, ticagrelor)

- Planned surgery within 6 months unless DAPT can be maintained

- Life expectancy <12 months due to a serious medical illness (e.g., advanced cancer, end-stage heart failure)

- Severe kidney dysfunction (CrCl <30 mL/min) without dialysis

- Concurrent participation in another investigational study

- Referral for coronary artery bypass grafting (CABG) after a heart team discussion

- Angiographic evidence of thrombus at the target lesion

- Angiographic evidence of significant dissection at the treatment site prior to intervention

- Lesion with a previously placed stent within 10mm (visual estimate)

- Last remaining vessel with severely compromised left ventricular function (LVEF <30%)

- Target lesion within a saphenous vein graft (SVG)