Slow Progression of Eruptive and Noneruptive Calcified Nodules After Atherectomy Monotherapy

Eruptive calcified nodules (CNs) are associated with poor outcomes after conventional stent- and balloon-based percutaneous coronary intervention, leaving optimal treatment strategies uncertain.

A 76-year-old woman presented with non-ST-segment elevation myocardial infarction. Coronary angiography and optical coherence tomography identified an eruptive CN, which was localized as the culprit lesion through functional assessment. Considering the risk of stent- and balloon-related failure, atherectomy-alone strategy, without adjunctive therapy, was performed. Serial optical coherence tomography demonstrated effective debulking with preserved vessel morphology at 5-month and 4-year follow-up without luminal compromise or recurrent events.

Given the inherently latent pathology of eruptive CN, atherectomy monotherapy, devoid of superfluous stimuli and permanent scaffolding, may be a viable strategy for selected lesions, provided sufficient ablation was obtained.

A minimal atherectomy-alone strategy for the eruptive CN may yield maximal legacy, facilitating treatment options and straightforward lifetime management should recurrences occur.