Document Type

Article

Publication Date

11-17-2025

Publication Title

Journal of Clinical Medicine

Volume

14

Issue

22

First page number:

1

Last page number:

29

Abstract

Calcified coronary lesions remain a challenge in percutaneous coronary intervention (PCI) in both situations of acute myocardial infarction (MI) and stable coronary syndrome. It significantly increases the risk of procedural complications due to difficulty in equipment delivery, balloon expansion, and stent delivery. Furthermore, stent thrombosis, dissection, perforation, and future in-stent restenosis occur more frequently in calcified coronary lesions, impacting repeat target vessel revascularization and increasing the risk of future MI. With intracoronary imaging (intravascular ultrasound and optical coherence tomography), peri-procedural success for treating calcified lesions has increased significantly. Different modalities of calcium modification techniques have since been introduced. This review will discuss the pathophysiology and phenotypes of calcium deposition in the coronary vessels, including eccentric calcified plaques and calcified nodules. We will also focus on calcium modification techniques and their mechanisms: (1) Balloon escalation technique, (2) intravascular lithotripsy, (3) orbital atherectomy, and (4) rotational atherectomy. We will focus on the strengths and limitations of each technique, based on current recommendations and expert consensus from SCAI. We will also provide contemporary evidence of each modality for treating different phenotypes of calcified lesions. In summary, this article provides a comprehensive review of current guidelines for optimizing the treatment of calcified coronary lesions in PCI.

Keywords

calcified coronary lesions; percutaneous coronary intervention; athrosclerotic plaque remodeling; coronary CT angiography; positron emission tomography; photon-counting CT; dual energy CT; balloon escalation technique; intravascular lithotripsy; rotational atherectomy; orbital atherectomy; laser atherectomy

Disciplines

Cardiovascular Diseases | Cardiovascular System

File Format

PDF

File Size

3400 KB

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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