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Review
. 2024 May 27;17(10):1187-1199.
doi: 10.1016/j.jcin.2024.03.032.

Calcified Nodule in Percutaneous Coronary Intervention: Therapeutic Challenges

Doosup Shin  1 , Keyvan Karimi Galougahi  1 , James C Spratt  2 , Akiko Maehara  3 , Carlos Collet  4 , Emanuele Barbato  5 , Flavio L Ribichini  6 , Nieves Gonzalo  7 , Koshiro Sakai  8 , Gary S Mintz  9 , Gregg W Stone  10 , Evan Shlofmitz  1 , Richard A Shlofmitz  1 , Allen Jeremias  11 , Ziad A Ali  12
Affiliations
Free article
Review

Calcified Nodule in Percutaneous Coronary Intervention: Therapeutic Challenges

Doosup Shin et al. JACC Cardiovasc Interv. .
Free article

Abstract

Calcified nodules (CNs) are among the most challenging lesions to treat in contemporary percutaneous coronary intervention. CNs may be divided into 2 subtypes, eruptive and noneruptive, which have distinct histopathological and prognostic features. An eruptive CN is a biologically active lesion with a disrupted fibrous cap and possibly adherent thrombus, whereas a noneruptive CN has an intact fibrous cap and no adherent thrombus. The use of intravascular imaging may allow differentiation between the 2 subtypes, thus potentially guiding treatment strategy. Compared with noneruptive CNs, eruptive CNs are more likely to be deformable, resulting in better stent expansion, but are paradoxically associated with worse clinical outcomes, in part because of their frequent initial presentation as an acute coronary syndrome and subsequent reprotrusion of the CN into the vessel lumen through the stent struts. Pending the results of ongoing studies, a tailored therapeutic approach based on the distinct features of the different CNs may be of value.

Keywords: calcified nodule; intravascular ultrasound; nodular calcification; optical coherence tomography; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Galougahi has received speaking honoraria from Abbott. Dr Maehara has served as a consultant for Boston Scientific, Philips, and Shockwave Medical. Dr Spratt has received research grants from Shockwave Medical; and has received consultant fees from Shockwave Medical and Boston Scientific. Dr Collet has received research grants from Biosensor, Coroventis Research, Medis Medical Imaging, Pie Medical Imaging, CathWorks, Boston Scientific, Siemens, HeartFlow, and Abbott Vascular; and has received consultant fees from HeartFlow, OpSens, Abbott Vascular, and Philips Volcanumber. Dr Barbato has received speaker fees from Abbott Vascular, Boston Scientific, and GE. Dr Gonzalo has received research grant support from Abbott; and has received consultancy and speaker fees from Abbott, Boston Scientific, Philips, and Shockwave. Dr Mintz has served as a consultant for Boston Scientific, Abbott, Spectrawave, and Gentuity; and has received honoraria from Boston Scientific, Abbott, Spectrawave, and Gentuity. Dr Stone has received speaker honoraria from Medtronic, Pulnovo, Infraredx, Abiomed, Amgen, and Boehringer Ingelheim; has served as a consultant for Abbott, Daiichi-Sankyo, Ablative Solutions, CorFlow, Cardiomech, Robocath, Miracor, Vectorious, Apollo Therapeutics, Elucid Bio, Valfix, TherOx, HeartFlow, Neovasc, Ancora, Occlutech, Impulse Dynamics, Adona Medical, Millennia Biopharma, Oxitope, Cardiac Success, HighLife, Elixir, Remote Cardiac Enablement, and Aria; and holds equity/options in Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix, and Xenter. Dr Stone’s employer, Mount Sinai Hospital, has received research grants from Abbott, Abiomed, Bioventrix, Cardiovascular Systems Inc, Phillips, Biosense-Webster, Shockwave, Vascular Dynamics, Pulnovo, and V-wave. Dr E. Shlofmitz has served as a consultant to Abbott Vascular, Medtronic, and Opsens Medical. Dr R.A. Shlofmitz has served as a speaker for Shockwave Medical. Dr Jeremias has received institutional grants and consulting fees from Abbott Vascular and Philips/Volcano; and has received consultant fees from ACIST Medical and Boston Scientific. Dr Ali has received institutional grants from Abbott, Abiomed, ACIST Medical, Boston Scientific, Cardiovascular Systems Inc, Medtronic, Opsens Medical, Philips, and Shockwave Medical; has received personal fees from Amgen, AstraZeneca, and Boston Scientific; and holds equity in Elucid, Lifelink, Spectrawave, Shockwave, and Vital Connect. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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