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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
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Management strategies for heavily calcified coronary stenoses: an EAPCI clinical consensus statement in collaboration

Emanuele Barbato1, Emanuele Gallinoro2, Mohamed Abdel-Wahab3

  • 1Department of Clinical and Molecular Medicine, Sapienza University, Via di Grottarossa n. 1035, Rome, 00189, Italy.

European Heart Journal
|May 19, 2023
PubMed

Insights

Percutaneous coronary interventions (PCI) for severely calcified coronary artery disease are increasing due to new technologies and an aging population. This consensus provides guidance on managing complex calcified lesions, from imaging to treatment selection and complication management.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Increasing prevalence of severely calcified coronary artery disease in elderly patients undergoing percutaneous coronary interventions (PCI).
  • Advancements in dedicated atherectomy devices (orbital, rotational) and intravascular lithotripsy have improved operator confidence in complex PCI.
  • Growing demand for revascularization procedures driven by increased life expectancy and expanded PCI networks.

Purpose of the Study:

  • To provide a comprehensive clinical consensus statement on the management of heavily calcified coronary stenoses.
  • To offer practical guidance on assessing calcium burden, selecting interventional tools, and managing complications.
  • To update recommendations following the 2015 EAPCI consensus on rotational atherectomy.

Main Methods:

  • Review and synthesis of current evidence and expert opinion on managing calcified coronary lesions.
  • Integration of non-invasive and invasive imaging techniques for calcium assessment and procedural planning.
  • Guidance on selecting optimal interventional tools (rotational atherectomy, orbital atherectomy, intravascular lithotripsy) based on lesion characteristics.

Main Results:

  • Detailed recommendations for using imaging modalities to quantify and characterize coronary calcification.
  • Structured approach to selecting the most appropriate interventional technique based on calcium morphology and location.
  • Consideration of clinical implications, including complication prevention, management strategies, and the importance of operator training.

Conclusions:

  • Effective management of heavily calcified coronary stenoses requires a multimodal approach integrating advanced imaging and tailored interventional strategies.
  • New and optimized technologies enhance the feasibility and safety of PCI in complex calcified lesions.
  • Adherence to consensus guidelines and adequate training are crucial for successful outcomes in treating patients with severe coronary calcification.

Keywords:
AtherectomyCalcified lesionsCalciumCutting balloonsIntravascular imagingLithotripsyPlaque modification

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