Breaking the deadlock of calcified coronary artery lesions: A contemporary review

Abstract

Percutaneous coronary intervention (PCI) of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse longterm clinical outcomes compared to noncalcified lesions. Adequate lesion preparation through calcium modification is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes. There are numerous calcium modification devices currently available whose usefulness depends on the nature of the calcific disease and its anatomical distribution. It can be challenging for the interventionists to decide which device is best suited for their patient. There is also emerging evidence for intravascular imaging in guiding selection of calcium modification devices using parameters such as calcium distribution and depth that directly impact on procedural success and clinical outcomes. In this review we aim to discuss the pathophysiology of coronary calcification, evaluate strategies and technologies of calcium modification and propose an AM A -S-A algorithm in managing calcified coronary lesions.

Bail-out therapy in ST-segment elevation myocardial infarction due to calcified lesion causing stent underexpansion: Intravascular lithotripsy is in the lead

“…PCI of severely calcified lesions is known to result in lower procedural success rates, higher complication rates, and worse longterm clinical outcomes compared to noncalcified lesions [1] . Calcium modification through adequate pre-dilation is crucial in ensuring procedural success and reducing adverse cardiovascular outcomes.…”

“…Severe coronary calcification may impair device delivery, stent apposition, and inhibit expansion, thus predisposing to stent thrombosis [1] . There are limited options once non-compliant balloons have failed to achieve optimal stent expansion.…”

Kawasaki Related Coronary Artery Disease Refractory to Angioplasty: The Role of Intravascular Shockwave Lithotripsy

“…Heavily calcified lesions are often difficult to treat and are associated with significant complications either during PCI (e.g., dissection, perforation) or afterward (e.g., restenosis, stent fractures, stent thrombosis) [ 9 ]. Currently available solutions for these types of lesions, such as high-pressure noncompliant balloons, cutting/scoring balloons, and MRA, rely on tissue compression or debulking, in order to fracture calcium and facilitate optimal stent deployment [ 10 ]. The overall procedural success rate can be low with lesions containing deep, thick, or eccentric calcifications, and current procedural options (i.e., specialty balloons, atherectomy, and high-pressure noncompliant balloons) have similar clinical outcomes [ 9 ].…”

Percutaneous coronary intervention in calcified stenoses: a protocol for a systematic review with meta-analysis, trial sequential analysis and network meta-analysis

“…(1) Rotational atherectomy uses a catheter with a rotating diamond-burr, which is advanced through the calcified segment to pulverise the superficial calcification. 18 (2) Orbital atherectomy uses a catheter with an eccentrically mounted diamond-coated crown that rotates and pulverises the superficial calcification. 18 Potential complications of rotational and orbital atherectomy include coronary perforation, dissection and embolisation of debris with risks of myocardial infarction or slow-flow/no-reflow phenomena.…”

“…In addition to conventional techniques, several specialised techniques are available to optimise lesion preparation and stent expansion in calcified stenoses. (1) Rotational atherectomy uses a catheter with a rotating diamond-burr, which is advanced through the calcified segment to pulverise the superficial calcification 18. (2) Orbital atherectomy uses a catheter with an eccentrically mounted diamond-coated crown that rotates and pulverises the superficial calcification 18.…”