Related Experiment Video
Updated: May 5, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Procedural Impact of Advanced Calcific Plaque Modification Devices Within Percutaneous Revascularization of Chronic
Giuseppe Vadalà1, Kambis Mashayekhi2, Michael Behnes3
1Division of Cardiology, University Hospital "P. Giaccone," Palermo, Italy.
Insights
Advanced calcific plaque modification devices (ACPMDs) improve technical success and reduce major adverse cardiac and cerebrovascular events (MACCE) during percutaneous coronary intervention (PCI) for complex chronic total occlusions (CTOs). Severe calcification increases procedural complexity but not MACCE when ACPMDs are used.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Significant calcifications in coronary chronic total occlusions (CTOs) complicate percutaneous coronary intervention (PCI) and increase complication risks.
- Expert consensus recommends advanced calcific plaque modification devices (ACPMDs) for calcified CTO PCI, but procedural impact data are limited.
Purpose of the Study:
- To analyze trends, settings, and outcomes of PCI for severely calcified CTOs.
- To compare PCI outcomes with and without the use of ACPMDs in severely calcified CTOs.
Main Methods:
- Analysis of 15,329 CTO PCI cases from the European Registry of Chronic Total Occlusion (ERCTO) (2021-2023).
- Population divided into non-severe (n=12,289) and severe (n=3,040) calcification groups.
- Severe calcification group further stratified into non-ACPMD (n=2,253) and ACPMD (n=787) subgroups.
Main Results:
- The ACPMD group showed higher antegrade wiring (77.9% vs 49.2%) and technical success (97.6% vs 79.1%) rates compared to the non-ACPMD group.
- ACPMD use was associated with lower periprocedural and in-hospital MACCE (1.8% vs 3.5%).
- Severe calcification independently predicted technical failure (OR: 3.13) but not MACCE (OR: 0.88).
Conclusions:
- Utilizing ACPMDs in severely calcified CTO PCI is linked to enhanced technical success and reduced MACCE rates.
- Severe coronary calcification identified on angiography signifies clinical and procedural complexity, correlating with technical failure risk but not MACCE.
Background:
Significant calcifications within a coronary chronic total occlusion (CTO) increase procedural complexity and the risk for complications. Expert consensus documents recommend the use of advanced calcific plaque modification devices (ACPMDs) for calcified CTO percutaneous coronary intervention (PCI), whereas data on their procedural impact are limited.
Objectives:
The aim of this study was to describe trends, settings, and outcomes of PCI of severely calcified CTO performed with and without ACPMDs.
Methods:
Data from 15,329 CTO PCIs enrolled in the ERCTO (European Registry of Chronic Total Occlusion) between 2021 and 2023 were analyzed. On the basis of the presence of severe calcifications within the CTO, the study population was divided into 2 groups: nonsevere (n = 12,289) and severe (n = 3,040) calcium. Then, the severe group was divided into non-ACPMD (n = 2,253) and ACPMD (n = 787), according to the use of ACPMDs.
Results:
Compared with the non-ACPMD group, the ACPMD group had higher rates of antegrade wiring (77.9% vs 49.2%; P < 0.001) and technical success (97.6% vs 79.1%; P = 0.001) and lower rates of periprocedural and in-hospital major adverse cardiac and cerebrovascular events (MACCE) (1.8% vs 3.5%; P = 0.001). A severe amount of calcium was independently associated with technical failure (OR: 3.13; 95% CI: 2.43-4.09; P < 0.001) but not with MACCE (OR: 0.88; 95% CI: 0.58-1.35; P = 0.15). Furthermore, extraplaque crossing was independently associated with MACCE (antegrade dissection and re-entry without retrograde contribution: OR: 3.12; 95% CI: 1.79-4.20; P < 0.001; antegrade dissection and re-entry with retrograde contribution: OR: 3.12; 95% CI: 1.67-4.11; P = 0.049; retrograde dissection and re-entry: OR: 1.90; 95% CI: 1.25-2.86; P = 0.002).
Conclusions:
Applying ACPMDs in severely calcified CTO to PCI was associated with higher technical success and lower MACCE rates. The presence of severe coronary calcification on coronary angiography was a marker of clinical and procedural complexity and was associated with technical failure but not with MACCE.
More Related Videos
08:12Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care