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Calcium is an essential signaling molecule required for various cellular functions. Calcium pumps and ion channels on cell and organellar membranes, such as those on the endoplasmic reticulum (ER), regulate calcium concentrations inside the cell. They remain closed, keeping the cytosolic calcium levels low at a resting state.
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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Calcium modifying dedicated balloons: a contemporary review.

Giuseppe Colletti1, Zoltan Ruzsa2,3, Olivier Gach4

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Frontiers in Cardiovascular Medicine
|April 27, 2026
PubMed
Summary

This review guides the use of specialized balloons for calcified coronary lesions, crucial for percutaneous coronary intervention (PCI) success. Proper device selection and technique improve outcomes in treating complex coronary artery disease.

Keywords:
OPN NC ballooncalcified coronary lesioncoronary artery diseasecutting balloonintravascular imagingpercutaneous coronary interventionscoring balloon

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Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Calcified coronary lesions pose significant challenges during percutaneous coronary intervention (PCI).
  • These lesions often result in suboptimal stent expansion, restenosis, and adverse clinical events.
  • Existing plaque modification technologies require clearer guidance for optimal use of balloon-based devices.

Purpose of the Study:

  • To review evidence on scoring balloons, cutting balloons, and ultra-high-pressure (OPN NC) balloons for treating calcified coronary disease.
  • To define the specific roles and indications for these devices based on lesion morphology and procedural context.
  • To emphasize the importance of intravascular imaging in guiding device selection and confirming plaque modification.

Main Methods:

  • Comprehensive review of current evidence on scoring, cutting, and OPN NC balloons.
  • Analysis of how lesion morphology, calcium characteristics, and procedural factors influence device choice.
  • Evaluation of the role of intravascular imaging in characterizing calcium and guiding interventions.

Main Results:

  • Scoring balloons are effective for eccentric calcium due to controlled focal stress.
  • Cutting balloons facilitate intimal incisions and fracture of concentric/mixed calcification.
  • OPN NC balloons serve as a last-resort option for undilatable lesions, with repeated inflations potentially enhancing calcium disruption.

Conclusions:

  • Calcium-modifying balloons offer versatile strategies for calcified coronary disease, usable as first-line or adjunctive therapy.
  • Optimal device performance depends on lesion selection, procedural technique, and intravascular imaging guidance.
  • An individualized, integrated, and morphology-tailored multimodality approach is the most pragmatic strategy for complex calcified lesions.