The Impact and Pathophysiologic Consequences of Coronary Artery Calcium Deposition in Percutaneous Coronary Interventions.

The presence of coronary artery calcium is indicative of advanced coronary artery disease and is a predictor of clinical events including stroke, myocardial infarction, and cardiac arrest. Recognition of the risk factors and the clinical implications associated with coronary artery calcium is vital in identifying both preventative measures as well as treatment options. Non-invasive and invasive strategies can help quantify these calcified lesions and aid in appropriate patient selection for possible use of atheroablative devices. While mild to moderately calcified lesions can be predilated with balloon angioplasty, severely calcified vessels may be resistant to adequate predilatation and preclude stent delivery and optimal expansion, potentially increasing the risk of early and late complications. The use of atherectomy devices is an invaluable treatment option for these complex lesions, given the ability for plaque modification and changing the compliance of heavily calcified vessels, increasing procedural success rates.