Current options for the management of calcified lesions

Abstract

ABSTRACT Severe coronary calcium increases the complexity of percutaneous coronary interventions. It may affect the adequate preparation of the lesion, proper stent expansion and apposition and increase the risk of stent thrombosis and restenosis. The techniques available for the management of severe calcified lesions can be divided into 2 groups: non-balloon and balloon-based technologies. Rotational atherectomy has been the predominant technique to treat severe calcified lesions. As a matter of fact, there are new devices available that facilitate the modification of the plaque such as the new lithoplasty balloon that involves the use of high-energy mechanical pulses to crack coronary calcium. Coronary lithoplasty is an easy technique with a short learning curve that seems to be more effective on deep calcium by increasing luminal compliance. This may revolutionize the standard approach for the management of severe calcified coronary lesions. Also, the role of intravascular imaging is essential to select the most appropriate plaque-modification device and assess the optimal stent result. This review provides an overview of the techniques available and evidence on the currently approved devices to treat calcified lesions.

Keywords

• Rotational atherectomy
• Orbital atherectomy
• Excimer laser
• Coronary lithoplasty