Year: 2023
Type: editorial
Abstract: Calcified coronary disease represent a challenge for treatment with percutaneous coronary intervention (PCI) and are associated with worse outcomes compared to treatment of noncalcified coronary disease. 1 Severe calcium can make delivery of equipment during PCI challenging and, if not adequately addressed, can lead to stent under-expansion, which is associated with stent thrombosis and in-stent restenosis. 2 Stent thrombosis is associated with a >20% mortality and in-stent restenosis due to underlying unfractured calcium is much more difficult to treat. 3 A greater proportion of patients undergoing PCI in the contemporary era are older and with diabetes mellitus, hypertension, and renal insufficiency, factors of which also associated with coronary calcification.4,5 Eccentric calcium in target lesions often creates additional difficulty for PCI as the use of calcium modification techniques may be limited.Noncompliant balloons may direct force away from an eccentric calcified lesion and can lead to dissection or vessel perforation due to expansion towards the more compliant non-calcified segment.Cutting and scoring balloons can assist in fractures of eccentric calcium, particularly if the calcium is thin.Atherectomy can be useful for ablation of eccentric calcium, especially in long calcified lesions.However, the utility of rotational atherectomy may be limited by the direction of wire bias and lumen size at the time atherectomy is performed, and the use of both orbital and rotational may be limited in the setting of severe tortuosity, severe dissection, or thrombus.6 Furthermore, augmentation of the acoustic mechanical energy generated from excimer laser coronary atherectomy to fracture calcium may require off-label injection of contrast.Intravascular lithotripsy (IVL), a novel approach to address calcified lesions, was approved for use in coronary arteries by the U.S. Food and Drug Administration in 2021.IVL delivers pulsatile sonic pressure waves to fracture calcium.7 Given the balloon-based delivery system, IVL is relatively easier for operators to use compared with atherectomy, and has been shown to be safe and effective in facilitating PCI in severely calcified lesions.
Authors: Neel M. Butala, Binita Shah
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4387709846