Use of Calcium Modification in Percutaneous Coronary Intervention: A Comprehensive Review

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology

Background:

• Calcified coronary lesions complicate percutaneous coronary intervention (PCI), increasing procedural risks and adverse events.
• Challenges include difficult equipment delivery, balloon/stent expansion, and higher rates of stent thrombosis, dissection, and restenosis.

Purpose of the Study:

• To review the pathophysiology and phenotypes of coronary calcification.
• To discuss various calcium modification techniques used in PCI.
• To evaluate the strengths, limitations, and evidence for each technique based on current guidelines and expert consensus.

Main Methods:

• Literature review focusing on coronary calcification pathophysiology and PCI techniques.
• Analysis of calcium modification modalities: balloon angioplasty, intravascular lithotripsy, orbital atherectomy, and rotational atherectomy.
• Evaluation of evidence and recommendations from expert consensus (SCAI) and guidelines.

Main Results:

• Intracoronary imaging has improved peri-procedural success in treating calcified lesions.
• Different phenotypes of calcification (e.g., eccentric plaques, calcified nodules) require tailored approaches.
• Each technique has specific strengths and limitations impacting clinical application.

Conclusions:

• Optimizing PCI for calcified lesions requires understanding pathophysiology and selecting appropriate calcium modification techniques.
• Current evidence and expert consensus guide the selection of modalities for different calcification phenotypes.
• Comprehensive review provides insights into current guidelines for managing complex calcified coronary lesions.