Coronary calcification is a major determinant of PCI complexity and failure. Balloon-based plaque-modifying devices —such as cutting balloons and intravascular lithotripsy (IVL)— are increasingly used in clinical practice. However, direct comparative evidence remains limited.
ShortCUT is the first randomized, multicenter study designed to compare the efficacy, safety, and cost of cutting balloon vs. IVL in moderate-to-severely calcified coronary disease treated with intravascular imaging-guided PCI.
Patients were allocated 1:1 to cutting balloon or IVL therapy. All underwent DES implantation under IVUS guidance. The primary endpoint was post-procedure minimum stent area (MSA) at the site of greatest calcification, assessed by an independent core lab.
A total of 413 patients were enrolled at 21 U.S. centers. Cutting balloon angioplasty met non-inferiority for post-PCI MSA (non-inferiority margin 1.2 mm²), with no significant differences in stent expansion, calcium fracture, procedural success, or major adverse outcomes.
A key finding was cost impact: IVL was associated with significantly higher procedural expenses, with a mean per-vessel difference of USD 3632 (95% CI 2833–4418; p<0.001).
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Results were consistent in the subgroup undergoing planned atherectomy. In patients without atherectomy, cutting balloon did not meet non-inferiority for MSA but did for expansion and calcium fracture metrics.
Conclusion
ShortCUT shows that cutting balloon angioplasty is a reasonable, safe, and less costly alternative to IVL in IVUS-guided PCI.
Presented by Suzanne J. Baron at TCT 2025 Late-Breaking Clinical Trials, October 26, San Francisco, USA.
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