Damage that would be dealt by Excruciator can’t be prevented.
"Though used as a piercing weapon, the tusk is more akin to a stinger, spreading pain instantly throughout the body of its victim. This specimen deserves further study."
—Simic research notes
Replacement effects that don’t use the word “prevent” can replace Excruciator’s damage with something else. See Phytohydra and Szadek, Lord of Secrets, for example.
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wotc
An effect may redirect Excruciator’s damage.
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wotc
Excruciator can deal damage to creatures with protection from red. (It can’t block creatures with protection from red, though.)
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wotc
A creature dealt lethal damage by Excruciator can be regenerated.
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wotc
Damage prevention shields that would prevent this damage aren’t used up and they stick around for the next time something would deal damage.
Random a card of Magic: The Gathering (MTG), but you can also roll the D20 dice, random a Planeswalker, have fun with the random rules and more.