Percutaneous Revascularization of Thrombotic and Calcified Coronary Lesions

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Percutaneous coronary intervention (PCI) for thrombotic and heavily calcified lesions presents significant challenges.
• Difficulty in wiring, restoring flow, and implanting stents can lead to complications.
• Stent underexpansion and malapposition are major drivers of adverse events like restenosis and thrombosis.

Purpose of the Study:

• To review the prevalence, predictors, and outcomes of treating
• hard-rock
• thrombotic lesions with PCI.
• To highlight the critical role of imaging and physiological assessments in guiding these interventions.
• To provide an overview of novel technologies for managing complex coronary lesions.

Main Methods:

• Review of current evidence on imaging and physiological assessments in PCI for complex lesions.
• Focus on multimodal imaging for characterizing thrombi and calcification.
• Exploration of cutting-edge debulking and stent optimization technologies.

Main Results:

• Multimodal imaging is crucial for characterizing high-risk lesions.
• Understanding thrombus formation and calcium distribution aids in optimal revascularization strategy selection.
• Advanced imaging and planning improve procedural success and long-term clinical outcomes.

Conclusions:

• Thorough lesion characterization using imaging is essential for successful PCI in complex thrombotic and calcified lesions.
• Careful patient selection and procedural planning with advanced technologies can mitigate complications.
• Optimizing stent implantation based on imaging guidance improves clinical results.