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Review
. 2023 Jul 11;12(14):4622.
doi: 10.3390/jcm12144622.

The Role of Intracoronary Imaging for the Management of Calcified Lesions

Stylianos Petousis  1 , Emmanouil Skalidis  1 , Evangelos Zacharis  1 , George Kochiadakis  1 , Michalis Hamilos  1
Affiliations
Review

The Role of Intracoronary Imaging for the Management of Calcified Lesions

Stylianos Petousis et al. J Clin Med. .

Abstract

Interventional cardiologists in everyday practice are often confronted with calcified coronary lesions indicated for percutaneous transluminal coronary angioplasty (PTCA). PTCA of calcified lesions is associated with diverse technical challenges resulting in suboptimal coronary stenting and adverse long-term clinical outcomes. Angiography itself offers limited information regarding coronary calcification, and the adjuvant use of intracoronary imaging such as intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT) can guide the treatment of calcified coronary lesions, optimizing the different stages of the procedure. This review offers a description of why, when, and how to use intracoronary imaging for PTCA of calcified coronary lesions in order to obtain the most favorable results. We used the PubMed and Google Scholar databases to search for relevant articles. Keywords were calcified coronary lesions, intracoronary imaging, IVUS, OCT, coronary calcium modification techniques, PTCA, and artificial intelligence in intracoronary imaging. A total of 192 articles were identified. Ninety-one were excluded because of repetitive or non-important information.

Keywords: IVUS; OCT; PTCA; calcified coronary lesions.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
IVUS images during PTCA of calcified lesions. Legend: (A). Calcified nodule. (Β). Concentric calcium of 270 degrees. (C). Presence of calcium fractures after IVL treatment (white arrows). (D). IVUS after stent implantation. Abbreviations. IVUS: IntraVascular UltraSound, PTCA: Percutaneous Transluminal Coronary Angioplasty.
Figure 2
Figure 2
OCT images of coronary calcified lesions. Legend: (A). Concentric calcium appearance. (B). Calcium fractures. (C). Calcified nodules. (D). Eccentric calcium appearance. Abbreviation: OCT: Optical Coherence Tomography (Images are courtesy of Abbott, Diegem, Belgium).
Figure 3
Figure 3
Use of intracoronary imaging for the treatment of PCI indicated calcified lesions.
Figure 4
Figure 4
Algorithm of the use of intracoronary imaging in calcified lesions with indication for PCI. Abbreviations: PCI: Percutaneous coronary intervention, ICI: Intracoronary imaging, IVUS: IntraVascular UltraSound, OCT: Optical Coherence Tomography, NC: Non-compliant. Leggend: Asterisk * refers to intracoronary imaging high risk criteria as follows: IVUS high risk criteria: 1. Superficial calcium of >270° (longer than 5 mm), 2. 360° superficial calcium, 3. Calcified nodule, 4. Vessel diameter ≤ 3.5 mm, OCT high risk criteria: 1. Calcium max angle > 180°, 2. Calcium max thickness > 0.5 mm, 3. Calcium length > 5 mm.
See this image and copyright information in PMC

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