Type and duration of antithrombotic therapy after treatment of severely calcified lesions

Giulia Alagna; Alessia Cascone; Antonino Micari; Giancarlo Trimarchi; Francesca Campanella; Giovanni Taverna; Saro Pistorio; Giuseppe Andò; Giulia Alagna; Alessia Cascone; Antonino Micari; Giancarlo Trimarchi; Francesca Campanella; Giovanni Taverna; Saro Pistorio; Giuseppe Andò

doi:10.3934/medsci.2025004

AIMS Medical Science

2025, Volume 12, Issue 1: 38-62. doi: 10.3934/medsci.2025004

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Type and duration of antithrombotic therapy after treatment of severely calcified lesions

Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy

Received: 05 July 2024 Revised: 03 December 2024 Accepted: 10 December 2024 Published: 19 February 2025

The presence of coronary artery calcification (CAC) increases with age, leading to a higher number and complexity of percutaneous coronary intervention (PCI) procedures in older patients. Chronic kidney disease (CKD) and diabetes are also associated with the development of CAC. These significant comorbidities, combined with PCI of severely calcified lesions, pose major challenges due to technical difficulties and potentially compromise both short- and long-term outcomes. Patients undergoing PCI for heavily calcified lesions should receive optimal anticoagulation and antiplatelet therapy according to current guidelines. However, data on the potential use of more potent P2Y12 inhibitors (ticagrelor, prasugrel) instead of clopidogrel as standard practice in elective PCI of CAC are limited. This is due to varying classifications used to define complex PCI in meta-analyses, and the extreme heterogeneity of the populations studied in terms of clinical presentation. The duration of antiplatelet therapy with aspirin and a P2Y12 inhibitor can be prolonged in selected patients. However, there is increasing evidence supporting the validity of P2Y12 inhibitor monotherapy after standard DAPT, adopting an aspirin-free and tailored de-escalation strategy.
- severely calcified lesions,
- coronary artery calcifications,
- complex percutaneous coronary intervention,
- dual antiplatelet therapy,
- P2Y12 inhibitors
Citation: Giulia Alagna, Alessia Cascone, Antonino Micari, Giancarlo Trimarchi, Francesca Campanella, Giovanni Taverna, Saro Pistorio, Giuseppe Andò. Type and duration of antithrombotic therapy after treatment of severely calcified lesions[J]. AIMS Medical Science, 2025, 12(1): 38-62. doi: 10.3934/medsci.2025004

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Abstract

The presence of coronary artery calcification (CAC) increases with age, leading to a higher number and complexity of percutaneous coronary intervention (PCI) procedures in older patients. Chronic kidney disease (CKD) and diabetes are also associated with the development of CAC. These significant comorbidities, combined with PCI of severely calcified lesions, pose major challenges due to technical difficulties and potentially compromise both short- and long-term outcomes. Patients undergoing PCI for heavily calcified lesions should receive optimal anticoagulation and antiplatelet therapy according to current guidelines. However, data on the potential use of more potent P2Y12 inhibitors (ticagrelor, prasugrel) instead of clopidogrel as standard practice in elective PCI of CAC are limited. This is due to varying classifications used to define complex PCI in meta-analyses, and the extreme heterogeneity of the populations studied in terms of clinical presentation. The duration of antiplatelet therapy with aspirin and a P2Y12 inhibitor can be prolonged in selected patients. However, there is increasing evidence supporting the validity of P2Y12 inhibitor monotherapy after standard DAPT, adopting an aspirin-free and tailored de-escalation strategy.

Acknowledgments

The authors are institutionally funded by the University of Messina. No external funding has been requested in preparing the article.

Conflict of interest

The authors declare no conflict of interest.

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