Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Moderate to severe calcification affects about one-third of coronary lesions in patients with ischemic heart disease and acute coronary syndromes.
• Calcified lesions are associated with poorer procedural results and long-term outcomes.

Purpose of the Study:

• To review the current state-of-the-art in evaluating and treating calcified coronary lesions.

Main Methods:

• Review of current literature and technologies for the assessment and treatment of calcified coronary lesions.
• Discussion of intravascular imaging modalities (intravascular ultrasound, optical coherence tomography) for lesion assessment.
• Overview of established and novel technologies for coronary calcium modification (rotational atherectomy, excimer laser, orbital atherectomy, intravascular lithotripsy).

Main Results:

• Intravascular imaging is essential for guiding percutaneous coronary intervention in severely calcified lesions.
• New technologies like orbital atherectomy and intravascular lithotripsy enhance coronary calcium modification and facilitate stent expansion.
• Achieving calcium fracture improves lesion compliance and is critical for optimal stent implantation.

Conclusions:

• An algorithmic approach integrating intravascular imaging with various atherectomy technologies enables safe and effective treatment of heavily calcified coronary lesions.
• Intravascular imaging-guided strategies are key to optimizing stent expansion and patient outcomes.