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Review
. 2024 Feb 22;12(5):520.
doi: 10.3390/healthcare12050520.

The Significance of Coronary Artery Calcification for Percutaneous Coronary Interventions

Paweł Lis  1 , Marek Rajzer  1 , Łukasz Klima  1
Affiliations
Review

The Significance of Coronary Artery Calcification for Percutaneous Coronary Interventions

Paweł Lis et al. Healthcare (Basel). .

Abstract

The prevalence of calcium deposits in coronary arteries grows with age. Risk factors include, e.g., diabetes and chronic kidney disease. There are several underlying pathophysiological mechanisms of calcium deposition. Severe calcification increases the complexity of percutaneous coronary interventions. Invasive techniques to modify the calcified atherosclerotic plaque before stenting have been developed over the last years. They include balloon- and non-balloon-based techniques. Rotational atherectomy has been the most common technique to treat calcified lesions but new techniques are emerging (orbital atherectomy, intravascular lithotripsy, laser atherectomy). The use of intravascular imaging (intravascular ultrasound and optical coherence tomography) is especially important during the procedures in order to choose the optimal strategy and to assess the final effect of the procedure. This review provides an overview of the role of coronary calcification for percutaneous coronary interventions.

Keywords: coronary artery calcification; intravascular lithotripsy; intravascular ultrasound; optical coherence tomography; orbital atherectomy; rotational atherectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A 33-year-old patient with end-stage chronic kidney disease requiring dialysis. (A) massive calcification (marked by arrows) in left anterior descending (LAD) artery before contrast administration; (B) angiography of LAD revealing significant stenoses; (C) OCT cross-section image of LAD with circumferential calcification.
Figure 2
Figure 2
Coronary calcification visualized using different imaging modalities: (A) coronary angiography; (B) intravascular ultrasound; (C) optical coherence tomography (circumferential calcium, 360° arch). Arrows are pointing at calcium deposits.
Figure 3
Figure 3
Rotational atherectomy, schematic representation.
Figure 4
Figure 4
Summary of recommendations for invasive approach in heavily calcified lesions. Adapted from [21]. Abbreviations: CT, computed tomography; IVUS, intravascular ultrasound; OCT, optical coherence tomography; NC, non-compliant; C/S, cutting/scoring; SHP, super-high-pressure; PCI, percutaneous coronary intervention; IVL, intravascular lithotripsy.
Figure 5
Figure 5
(A) Stent in proximal right coronary artery (RCA, stent marked by white arrow) and massive calcification in distal RCA (red arrows); (B) significant lesions distally to previously implanted stent (arrows); (C) 1. distal tip of the guide extension, 2. rotational atherectomy burr, 3. RotaWire Floppy (D) final angiography.
See this image and copyright information in PMC

References

    1. Wong N.D., Kouwabunpat D., Vo A.N., Detrano R.C., Eisenberg H., Goel M., Tobis J.M. Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: Relation to age and risk factors. Am. Heart J. 1994;127:422–430. doi: 10.1016/0002-8703(94)90133-3. - DOI - PubMed
    1. Burke A.P., Farb A., Malcom G., Virmani R. Effect of menopause on plaque morphologic characteristics in coronary athero-sclerosis. Am. Heart J. 2001;141:S58–S62. doi: 10.1067/mhj.2001.109946. - DOI - PubMed
    1. Mori H., Torii S., Kutyna M., Sakamoto A., Finn A.V., Virmani R. Coronary Artery Calcification and its Progression: What Does it Really Mean? J. Am. Coll. Cardiol. Cardiovasc. Imaging. 2018;11:127–142. doi: 10.1016/j.jcmg.2017.10.012. - DOI - PubMed
    1. Kalra S.S., Shanahan C.M. Vascular calcification and hypertension: Cause and effect. Ann. Med. 2012;44((Suppl. 1)):S85–S92. doi: 10.3109/07853890.2012.660498. - DOI - PubMed
    1. Madhavan M.V., Tarigopula M., Mintz G.S., Maehara A., Stone G.W., Généreux P. Coronary Artery Calcification: Pathogenesis and Prognostic Implications. J. Am. Coll. Cardiol. 2014;63:1703–1714. doi: 10.1016/j.jacc.2014.01.017. - DOI - PubMed

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