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Challenges With Severe Coronary Artery Calcification in Percutaneous Coronary Intervention: A Narrative Review of
Jay S Shavadia1, Minh N Vo2, Kevin R Bainey2
1Division of Cardiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada.
Insights
Severe calcified coronary lesions pose a challenge during percutaneous coronary intervention (PCI). Plaque modification devices like atherectomy and lithoplasty offer effective therapeutic alternatives for interventional cardiologists.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Atherosclerosis commonly leads to coronary calcification, complicating treatment.
- Aging populations and lower thresholds for percutaneous coronary intervention (PCI) increase the prevalence of severe calcific coronary stenoses.
- Conventional PCI techniques are often insufficient for recalcitrant calcified lesions.
Purpose of the Study:
- To summarize the principles, techniques, and evidence for devices used in treating severe coronary calcific lesions.
- To provide an overview of current therapeutic options for complex coronary artery disease.
- To highlight the role of plaque modification in interventional cardiology.
Main Methods:
- Review of current literature on coronary atherectomy and lithoplasty devices.
- Summary of procedural techniques for rotational, orbital, laser atherectomy, and shockwave lithoplasty.
- Analysis of contemporary evidence supporting these devices for severe calcific lesions.
Main Results:
- Coronary atherectomy and shockwave lithoplasty are established therapeutic alternatives for severe calcific coronary lesions.
- These devices facilitate plaque modification, improving the success of PCI.
- Evidence supports the safety and efficacy of various atherectomy modalities and lithoplasty.
Conclusions:
- Advanced plaque modification devices are crucial for managing complex calcified coronary lesions.
- Interventional cardiologists have multiple effective options for treating challenging stenoses.
- These technologies represent significant advancements in treating severe coronary calcification.
Abstract:
Coronary calcification often complicates atherosclerosis. With an aging population, coinciding with lower thresholds for coronary angiography and percutaneous coronary intervention (PCI), severe calcific coronary stenoses remain a challenge for interventional cardiologists. Although advances in coronary guidewires, percutaneous balloons, and adjunctive procedural devices have improved success of PCI, recalcitrant calcified lesions not amenable to the conventional technique frequently occur. Coronary atherectomy with plaque modification provides a therapeutic alternative. As such, various modalities such as rotational, orbital or laser atherectomy, and more recently shockwave lithoplasty have become therapeutic options for PCI. We provide a summary of the principles, technique, and contemporary evidence for these currently approved devices designed to treat severe coronary calcific lesions.
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