Current Management of Highly Calcified Coronary Lesions: An Overview of the Current Status

Abstract

The amount of coronary calcium strongly correlates with the degree of atherosclerosis and, therefore, with the rate of future cardiac events. Calcified coronary lesions still represent a challenge for interventional cardiologists, bringing not only a higher risk of immediate complications during percutaneous coronary interventions (PCI), but also a higher risk of late stent failure due to under-expansion and/or malapposition, and therefore, have a relevant prognostic impact. Accurate identification of the calcified plaques together with the analysis of their distribution pattern within the vessel wall by intracoronary imaging is important to improve the successful treatment of these lesions. The aim of this review is to guide readers through the assessment of the calcified plaque distribution using intracoronary imaging in order to select the best devices and strategies for plaque debulking and lesion preparation.

Safety and Efficacy of Orbital Atherectomy in the All-Comer Population: Mid-Term Results of the Lower Silesian Orbital Atherectomy Registry (LOAR)

“…If we compare the results obtained in our study with a similar “real-life” registry that refers to the alternative, novel debulking device—the S-IVL—we can see a similar level of short and mid-term TLR and MACE [ 48 , 49 , 50 ]. However, it is important to remember that the two devices appear to be designed for slightly different plaque morphologies based on their mechanism of action [ 51 , 52 , 53 ] (OA is more suitable for long, diffuse, tight lesions; S-IVL is more appropriate for short, focal, or profound calcifications). Therefore, the combination of different debulking methods may be useful to treat extreme-calcification-resistant lesions [ 21 , 22 ].…”