Contemporary Evidence-Based Diagnosis and Management of Severe Coronary Artery Calcification

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Heavily calcified coronary lesions pose significant challenges in percutaneous coronary intervention.
• Inadequate lesion preparation increases risks of incomplete stent deployment, complications, and stent failure.

Purpose of the Study:

• To review methods for evaluating coronary calcification.
• To discuss current and novel calcium modification techniques.
• To propose a management algorithm for calcified coronary lesions.

Main Methods:

• Review of non-invasive and invasive imaging for coronary calcification assessment.
• Discussion of established and emerging calcium modification devices and techniques.
• Synthesis of evidence to propose a clinical management strategy.

Main Results:

• Rotational atherectomy is a predominant technique, but novel methods like intravascular lithotripsy show promise.
• Intracoronary imaging is vital for characterising calcification severity and guiding device selection.
• An evidence-based algorithm can aid in individualised treatment strategies.

Conclusions:

• Optimising lesion preparation through calcium modification is key to successful percutaneous coronary intervention.
• A tailored approach using advanced imaging and appropriate devices improves outcomes for calcified lesions.
• Novel technologies offer effective and potentially less complex alternatives for calcium modification.