Combination Tools for Calcium Modification from RASER to Orbitalshock

Abstract

Coronary artery calcification is frequently encountered during percutaneous coronary intervention and its presence is associated with a higher risk of stent under-expansion which has been associated with long-term risk of stent failure. There are several different calcium modification strategies available, whether they be balloon-based devices (cutting/scoring and intravascular lithotripsy) or atherectomy devices (orbital atherectomy, rotational atherectomy, excimer laser coronary atherectomy) that are established for the modification of coronary calcification. Each strategy applies a different mechanism of action for calcium modulation and consequently the potential to combine modifying tools may offer synergistic advantages over device monotherapy. This article will focus on reviewing the evidence for the use of multiple calcium modification techniques and examine whether there really is any such synergistic effect of combining these tools.

Keywords: Calcium modification; coronary artery disease; coronary intervention.

Figure 1:. Suggested Calcium Modification Algorithm for Combing Multiple Modalities for Calcium Modification

Figure 2:. Comparison of Final Minimal Stent Area for Patients Treated with Rota-cut Compared with Rotational Atherectomy plus Standard Non-compliant Balloons in the Current Literature

Figure 3:. Diagram Demonstrating the Impact of a Rotashock Strategy for Calcium Modification

Figure 4:. Example of Orbital Shock

Figure 5:. Excimer Laser Coronary Atherectomy Shock Percutaneous Coronary Intervention to a Calcific Vein Graft that had Failed to Expand with Previous Non-compliant Balloons