Keyvan Karimi Galougahi1,2,3, Evan Shlofmitz4, Allen Jeremias4,5, Shawnbir Gogia5,6, Ajay J Kirtane5,6, Jonathan M Hill7, Dimitri Karmpaliotis5,6, Gary S Mintz5, Akiko Maehara5,6, Gregg W Stone5,8, Richard A Shlofmitz4, Ziad A Ali9,10,11,12. 1. Royal Prince Alfred Hospital, Sydney, Australia. 2. University of Sydney, Sydney, Australia. 3. Heart Research Institute, Sydney, Australia. 4. St. Francis Hospital - The Heart Center, Roslyn, NY, USA. 5. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. 6. Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. 7. Royal Brompton Hospital, London, UK. 8. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 9. St. Francis Hospital - The Heart Center, Roslyn, NY, USA. zali@crf.org. 10. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. zali@crf.org. 11. Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. zali@crf.org. 12. Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. zali@crf.org.
Abstract
PURPOSE OF REVIEW: Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions. RECENT FINDINGS: Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.
PURPOSE OF REVIEW: Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions. RECENT FINDINGS: Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.
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