Device indication for calcified coronary lesions based on coronary imaging findings

Abstract

Performing percutaneous coronary intervention (PCI) for calcified lesions is still a major challenge. Calcified lesions are a cause of inadequate dilatation, leading to poor short- and long-term PCI outcomes. It has been suggested that modification for calcification before stent implantation might improve outcomes by providing adequate dilation. Intravascular lithotripsy (IVL) is available under insurance reimbursement in December 2022 in Japan. IVL is one candidate for a treatment device to modify calcified lesions in addition to atherectomy, such as rotational and orbital atherectomy, and special balloons, such as scoring and cutting balloons. Although the evidence for the indications, of these devices is insufficient, they must be used appropriately in clinical practice. In this report, we propose a method for determining an indication of these devices solely as per the coronary imaging findings with intravascular ultrasound or optical coherent tomography. This consensus document represents the collective opinion of experts on the best current indications and should be changed based on future evidence. However, we believe that it represents the optimal criteria for selecting treatment options in the current situation.

Keywords: Coronary calcification; Intravascular lithotripsy; Intravascular ultrasound; Optical coherence tomography; Orbital atherectomy; Rotational atherectomy.

Fig. 1

Device selection strategy for calcified lesions. *When rotational/orbital atherectomy is considered appropriate. NC non-compliant, IVL intravascular lithotripsy, DES drug-eluting stent