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Review
. 2024 Jul 15;11(7):224.
doi: 10.3390/jcdd11070224.

Coronary Artery Calcium and Aging: Physiological Basis, Assessment, and Treatment Options in Percutaneous Coronary Intervention

Mohamed Abdirashid  1 , Umberto Barbero  2 , Chiara Cavallino  1 , Ludovica Maltese  1 , Elodi Bacci  1 , Danilo Reale  1 , Giorgio Marengo  2 , Michele De Benedictis  2 , Francesco Rametta  1 , Fabrizio Ugo  1
Affiliations
Review

Coronary Artery Calcium and Aging: Physiological Basis, Assessment, and Treatment Options in Percutaneous Coronary Intervention

Mohamed Abdirashid et al. J Cardiovasc Dev Dis. .

Abstract

Coronary artery calcification is a complex anatomical and histological pathology with different pathways that contribute to calcium deposit and calcification progression. As part of the atherosclerotic process, extensive calcifications are becoming more common and are associated with poorer PCI outcomes if not properly addressed. Since no drug has shown to be effective in changing this process once it is started, proper knowledge of the underlying pathogenesis and how to diagnose and manage it is essential in contemporary coronary intervention. Atherosclerosis is a pandemic disease, quickly spreading across the world and not limited anymore to the industrialized Western world. In this paper, we review the role of intracoronary imaging and the main technologies available and propose a simple and rational algorithm for the choice of a preferential first strategy in the treatment of severely calcified coronary atherosclerosis, followed by three emblematic cases on how we successively applied it.

Keywords: calcium; coronary artery disease; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Angiography appearance (A) and IVUS imaging (B) of a calcified plaque with a >270° calcium arch with a single bright wall without any evidence of what is behind.
Figure 2
Figure 2
The algorithm for the choice of the preferential first-choice strategy in the treatment of highly calcified lesions.
Figure 3
Figure 3
Case 1. Left coronary artery with left anterior descending (LAD) artery subocclusive stenosis (A). Orbital atherectomy attempt on LAD: The nose of the device is not crossing the lesion and the crown is not working. We can observe the tension from pushing the device and the ViperWire getting retracted (B). Dissection of proximal LAD and complete occlusion of the vessel. The patient had ST elevation and is unstable (C). Switch to RotaWire with microcatheter and rotational atherectomy (D).
Figure 4
Figure 4
Case 2. OCT scan showing a 270° thick calcium arch (A); subsequent intravascular lithotripsy (IVL) with a 4.0 × 12 mm shockwave balloon (B); OCT scan after IVL and predilatation: we can see the cracking of the calcium and an adequate lumen (C).
Figure 5
Figure 5
Case 3. OCT scan showed calcific plaque of mid left anterior descending (LAD) artery (A); OCT scan showed an emptied plaque of proximal LAD (B); orbital atherectomy on LAD (C); good result of atherectomy on LAD (D).
See this image and copyright information in PMC

References

    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
    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. Greenland P., LaBree L., Azen S.P., Doherty T.M., Detrano R.C. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291:210–215. doi: 10.1001/jama.291.2.210. - DOI - PubMed
    1. Kereiakes D.J., Hill J.M., Shlofmitz R.A., Klein A.J., Riley R.F., Price M.J., Herrmann H.C., Bachinsky W., Waksman R., Stone G.W., et al. Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Arteries: 2-Year Results-Disrupt CAD III Study. JACC Cardiovasc. Interv. 2023;16:2472–2474. doi: 10.1016/j.jcin.2023.07.010. - DOI - PubMed
    1. Rathore S., Matsuo H., Terashima M., Kinoshita Y., Kimura M., Tsuchikane E., Nasu K., Ehara M., Asakura Y., Katoh O., et al. Rotational atherectomy for fibro-calcific coronary artery disease in drug eluting stent era: Procedural outcomes and angiographic follow-up results. Catheter. Cardiovasc. Interv. 2010;75:919–927. doi: 10.1002/ccd.22437. - DOI - PubMed

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