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Updated: Sep 19, 2025

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
The Hidden Dangers of Calcium Morphology During PCI: Entrapment and Perforation
Teh Xin Yi1, I Chang Hsieh2, Jih Kai Yeh2
1School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Insights
Managing calcified coronary artery disease (CAD) during percutaneous coronary intervention (PCI) requires careful imaging to identify high-risk calcium. Early detection of specific calcium morphologies prevents serious procedural complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Percutaneous coronary intervention (PCI) for calcified coronary artery disease (CAD) presents significant management challenges.
- Complex calcifications can lead to procedural difficulties and adverse events.
Background:
The management of calcified coronary artery disease (CAD) during percutaneous coronary intervention (PCI) can lead to complications.
Case Summary:
A 72-year-old man had exertional dyspnea and severe calcified coronary artery disease (CAD) identified by means of coronary computed tomographic angiography (CTA). During PCI, a burr became entrapped in the mid left anterior descending artery (LAD) and was retrieved with the use of the push-and-pull technique. The procedure was further complicated by coronary perforation in the distal LAD during balloon angioplasty.
Discussion:
Imaging review revealed eccentric calcification with a "nutcracker" appearance in the mid-LAD, indicating a risk for burr entrapment, and a "waning crescent" calcium nodule in the distal LAD, which warranted a higher risk of perforation.
Take-Home Messages:
This case emphasizes the importance of early identification of high-risk calcium morphology with the use of imaging, including CTA and intravascular ultrasound to prevent procedural complications during PCI.
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