ShortCUT Compares Cutting Balloon Angioplasty Versus IVL Before Stenting in Calcified CAD

October 26, 2025—Results from the ShortCUT randomized controlled trial showed that cutting balloon (CB) angioplasty was noninferior to intravascular lithotripsy (IVL) in a direct comparison of the safety and efficacy of the two treatment strategies before drug-eluting stent (DES) implantation for the treatment of calcified coronary artery disease. The findings were presented by Suzanne J. Baron, MD, at the TCT 2025 scientific symposium.

According to the TCT press release, the ShortCUT trial was composed of a total of 413 patients with stable or unstable coronary artery disease with de novo calcified coronary lesions. The patients were randomized at 21 sites in the United States with baseline, lesion, and procedural characteristics similar in both groups.

The study included two cohorts: patients with planned upfront rotational atherectomy (n = 208); and patients in whom upfront rotational atherectomy was not planned (n = 205). In each cohort, patients were randomized to receive IVL- or CB-facilitated lesion preparation, noted TCT.

The study’s primary endpoint was postprocedural stent area at the site of maximal calcification as measured by core lab–adjudicated, high-definition intravascular ultrasound assessment.

As summarized in the TCT press release, the study findings included the following:

• For the postprocedural minimum stent area, the mean was 8.6 mm² ± 2.5 for IVL and 8 mm² ± 2.4 for CB (difference 0.6; 97.5% CI, -∞ to 1.1 mm²; P = .007 for noninferiority).
• There were no differences in stent expansion or calcium fractures between the two treatment arms in the total study population, as well as in both individual cohorts; however, interaction testing demonstrated that this effect may have varied based on whether atherectomy was planned.
• Average stent expansion at the site of maximum calcification was similar with 97.7 ± 24 for IVL and 97.7 ± 25.9 for CB (P = .99).
• The procedural cost difference was $3,632 (95% CI, $2,833 to $4,418; P < .001) with the main cost difference being driven by the cost of the randomized device.
• Strategy success—defined as stent delivery with a residual stenosis < 20% in the absence of significant angiographic complication and not having to use alternative calcium modification devices—was similar with 89.7% for IVL versus 89.2% for CB (P = .88).
• 30-day MACCE outcomes were the same between groups at 2.9%.

“As part of an imaging-based approach to [percutaneous coronary intervention] of significantly calcified coronary lesions, cutting balloon angioplasty is a reasonable strategy when compared with intravascular lithotripsy,” commented Dr. Baron in the TCT press release. “Not only is utilizing a cutting balloon safe and effective, it is also significantly less costly.”