How to identify and prepare calcified lesions safely and effectively

Bharat Khialani; Sara Malakouti; Sandeep Basavarajah; Leontin Lazar; Sylwia Iwanczyk; Bernardo Cortese; Bharat Khialani; Sara Malakouti; Sandeep Basavarajah; Leontin Lazar; Sylwia Iwanczyk; Bernardo Cortese

doi:10.3934/medsci.2025011

AIMS Medical Science

2025, Volume 12, Issue 2: 171-192. doi: 10.3934/medsci.2025011

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How to identify and prepare calcified lesions safely and effectively

1.
DCB Academy, Milano, Italy
2.
Tan Tock Seng Hospital, National Healthcare Group, Singapore
3.
Heartlands Hospital, University of Birmingham, United Kingdom
4.
Iuliu Hatieganu University of Medicine and Pharmacy, Medical Clinic no1, 4th Dept of Internal Medicine, Cluj-Napoca, Romania
5.
1st Department of Cardiology, Poznan University of Medical Sciences, Poland
6.
Harrington Heart & Vascular Insitute, University Hospitals Cleveland Medical Centre, Cleveland, OH, USA
7.
Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy

Received: 16 October 2024 Revised: 07 March 2025 Accepted: 14 April 2025 Published: 14 May 2025

Calcified coronary lesions pose significant challenges in percutaneous coronary intervention, which can impede device placement and stent expansion, thus leading to suboptimal clinical outcomes. This paper outlines a comprehensive approach for the safe and effective preparation of calcified lesions. It emphasizes the importance of pre-procedural planning using either coronary artery calcium scoring or computed tomography coronary angiography, as well as advanced intravascular imaging techniques with intravascular ultrasound and optical coherence tomography for accurate lesion assessment. Various lesion modification strategies are reviewed, including balloon angioplasty, rotational atherectomy, orbital atherectomy, laser atherectomy, and lithotripsy. The selection criteria for each technique based on the lesion characteristics, calcium morphology, and operator experience are discussed. Additionally, clinical data is analysed to provide evidence-based recommendations for practice. The paper concludes with a discussion on future directions and innovations alongside a proposed algorithm for the management of calcified coronary lesions, which is aimed at improving patient outcomes through technological advancements and refined procedural techniques.
- calcification,
- coronary,
- intracoronary imaging,
- atherectomy,
- lithotripsy,
- review
Citation: Bharat Khialani, Sara Malakouti, Sandeep Basavarajah, Leontin Lazar, Sylwia Iwanczyk, Bernardo Cortese. How to identify and prepare calcified lesions safely and effectively[J]. AIMS Medical Science, 2025, 12(2): 171-192. doi: 10.3934/medsci.2025011

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Abstract

Calcified coronary lesions pose significant challenges in percutaneous coronary intervention, which can impede device placement and stent expansion, thus leading to suboptimal clinical outcomes. This paper outlines a comprehensive approach for the safe and effective preparation of calcified lesions. It emphasizes the importance of pre-procedural planning using either coronary artery calcium scoring or computed tomography coronary angiography, as well as advanced intravascular imaging techniques with intravascular ultrasound and optical coherence tomography for accurate lesion assessment. Various lesion modification strategies are reviewed, including balloon angioplasty, rotational atherectomy, orbital atherectomy, laser atherectomy, and lithotripsy. The selection criteria for each technique based on the lesion characteristics, calcium morphology, and operator experience are discussed. Additionally, clinical data is analysed to provide evidence-based recommendations for practice. The paper concludes with a discussion on future directions and innovations alongside a proposed algorithm for the management of calcified coronary lesions, which is aimed at improving patient outcomes through technological advancements and refined procedural techniques.

Conflict of interest

Bernardo Cortese is an editorial board member for AIMS Medical Science and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

References

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