Author + information
- Received February 4, 2019
- Revision received March 7, 2019
- Accepted March 12, 2019
- Published online August 5, 2019.
- ↵∗Address for correspondence:
Prof. Adrian P. Banning, Oxford Heart Centre, Oxford University Hospitals, Headley Way, Oxford OX3 9DU, United Kingdom.
• Management of calcific obstructive coronary disease remains problematic.
• There have been recent advances in both imaging and lesion dilation technology.
• New interventional therapy paradigms will evolve facilitating improved clinical outcomes.
Patients with obstructive coronary lesions with a high calcium content (LHCC) have an exaggerated clinical risk, because the presence of calcification is associated with more extensive coronary atheroma and higher burden of comorbidities. Treatment of LHCC using percutaneous techniques is complex because of an increased risk of incomplete lesion preparation with suboptimal stent deployment and higher rates of acute and chronic stent failure. Rotational atherectomy has been the predominant technology for treatment of high-grade LHCC, but novel devices/technologies have entered clinical practice. It seems likely that combining enhanced intravascular imaging, which allows definition of the patterns of calcification with these new technologies, will herald a change in procedural algorithms for treatment of LHCC. This review provides an overview about LHCC with special focus on existing and emergent technologies. We also provide a proposed procedural algorithm to facilitate optimal use of technology according to specific features of LHCC and coronary anatomy.
- calcific coronary lesions
- complex percutaneous coronary interventions
- coronary lithoplasty
- excimer laser
- orbital atherectomy
- rotational atherectomy
↵∗ Drs. De Maria and Scarsini contributed equally to this paper.
Dr. De Maria has received a speaker fee from Miracor Medical SA. Dr. Scarsini has received an educational grant from EAPCI. Dr. Banning has received institutional funding for an interventional fellowship from Boston Scientific; has received speaker fees from Boston, Phillips, and Abbott Vascular; and is partially funded by the NHS NIHR Biomedical Research Centre, Oxford, United Kingdom.
- Received February 4, 2019.
- Revision received March 7, 2019.
- Accepted March 12, 2019.
- 2019 American College of Cardiology Foundation
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