Device indication for calcified coronary lesions based on coronary imaging findings

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Percutaneous coronary intervention (PCI) for calcified lesions presents significant challenges, often leading to inadequate stent expansion and suboptimal clinical outcomes.
• Calcified lesions require modification prior to stent implantation to ensure adequate dilatation and improve both short- and long-term results.

Purpose of the Study:

• To propose a standardized method for selecting appropriate devices for calcified lesion modification based on coronary imaging findings.
• To provide expert consensus on the optimal use of intravascular lithotripsy (IVL), atherectomy, and specialized balloons in current clinical practice.

Main Methods:

• Utilizing coronary imaging modalities, specifically intravascular ultrasound (IVUS) and optical coherent tomography (OCT), to assess lesion characteristics.
• Developing a consensus-based approach for device selection derived from expert opinions and current evidence.

Main Results:

• A proposed method for determining device indications based solely on intravascular imaging findings.
• Identification of IVL, rotational atherectomy, orbital atherectomy, scoring balloons, and cutting balloons as potential treatment options for calcified lesions.

Conclusions:

• Intravascular imaging is crucial for guiding the selection of devices for calcified lesion modification.
• This consensus document offers optimal criteria for current treatment selection, acknowledging the need for future evidence to refine indications.