Contemporary technologies to modify calcified plaque in coronary artery disease

Prog Cardiovasc Dis. 2021 Nov-Dec:69:18-26. doi: 10.1016/j.pcad.2021.07.003. Epub 2021 Jul 10.

Abstract

With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.

Keywords: Atherectomy; Calcifications; Excimer laser; Intracoronary imaging; Intravascular lithotripsy; Orbital; Rotational.

Publication types

  • Review

MeSH terms

  • Atherectomy, Coronary* / adverse effects
  • Coronary Angiography
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / therapy
  • Humans
  • Percutaneous Coronary Intervention*
  • Plaque, Atherosclerotic*
  • Treatment Outcome
  • Vascular Calcification* / diagnostic imaging
  • Vascular Calcification* / therapy