Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

doi:10.1007/s11886-021-01458-7

Review

. 2021 Mar 5;23(4):33.

doi: 10.1007/s11886-021-01458-7.

Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

Keyvan Karimi Galougahi^{1

2

3}, Evan Shlofmitz⁴, Allen Jeremias^{4

5}, Shawnbir Gogia^{5

6}, Ajay J Kirtane^{5

6}, Jonathan M Hill⁷, Dimitri Karmpaliotis^{5

6}, Gary S Mintz⁵, Akiko Maehara^{5

6}, Gregg W Stone^{5

8}, Richard A Shlofmitz⁴, Ziad A Ali^{9

10

11

12}

Affiliations

¹ Royal Prince Alfred Hospital, Sydney, Australia.
² University of Sydney, Sydney, Australia.
³ Heart Research Institute, Sydney, Australia.
⁴ St. Francis Hospital - The Heart Center, Roslyn, NY, USA.
⁵ Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
⁶ Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA.
⁷ Royal Brompton Hospital, London, UK.
⁸ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ St. Francis Hospital - The Heart Center, Roslyn, NY, USA. zali@crf.org.
¹⁰ Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. zali@crf.org.
¹¹ Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. zali@crf.org.
¹² Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. zali@crf.org.

PMID: 33666772
DOI: 10.1007/s11886-021-01458-7

Review

Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

Keyvan Karimi Galougahi et al. Curr Cardiol Rep. 2021.

. 2021 Mar 5;23(4):33.

doi: 10.1007/s11886-021-01458-7.

Authors

Affiliations

¹ Royal Prince Alfred Hospital, Sydney, Australia.
² University of Sydney, Sydney, Australia.
³ Heart Research Institute, Sydney, Australia.
⁴ St. Francis Hospital - The Heart Center, Roslyn, NY, USA.
⁵ Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.
⁶ Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA.
⁷ Royal Brompton Hospital, London, UK.
⁸ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ St. Francis Hospital - The Heart Center, Roslyn, NY, USA. zali@crf.org.
¹⁰ Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. zali@crf.org.
¹¹ Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA. zali@crf.org.
¹² Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. zali@crf.org.

PMID: 33666772
DOI: 10.1007/s11886-021-01458-7

Abstract

Purpose of review: Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions.

Recent findings: Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.

Keywords: Coronary calcification; Intravascular lithotripsy; Intravascular ultrasound; Optical coherence tomography; Orbital atherectomy; Rotational atherectomy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

1. Mori H, Torii S, Kutyna M, Sakamoto A, Finn AV, Virmani R. Coronary artery calcification and its progression: what does it really mean? JACC Cardiovasc Imaging. 2018;11(1):127–42. https://doi.org/10.1016/j.jcmg.2017.10.012 . - DOI
1. Huisman J, van der Heijden LC, Kok MM, Danse PW, Jessurun GA, Stoel MG, et al. Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: a patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II). Am Heart J. 2016;175:121–9. https://doi.org/10.1016/j.ahj.2016.02.012 . - DOI - PubMed
1. Copeland-Halperin RS, Baber U, Aquino M, Rajamanickam A, Roy S, Hasan C, et al. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: findings from a large multiethnic registry. Catheter Cardiovasc Interv. 2018;91(5):859–66. https://doi.org/10.1002/ccd.27204 . - DOI - PubMed
1. Bourantas CV, Zhang YJ, Garg S, Iqbal J, Valgimigli M, Windecker S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100(15):1158–64. https://doi.org/10.1136/heartjnl-2013-305180 . - DOI - PubMed
1. Wang X, Matsumura M, Mintz GS, Lee T, Zhang W, Cao Y, et al. In vivo calcium detection by comparing optical coherence tomography, intravascular ultrasound, and angiography. JACC Cardiovasc Imaging. 2017;10(8):869–79. https://doi.org/10.1016/j.jcmg.2017.05.014 Intravascular imaging study correlating angiographically visible and invisible calcium with intravascular imaging and their impact on stent expansion. - DOI - PubMed

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[1] Mori H, Torii S, Kutyna M, Sakamoto A, Finn AV, Virmani R. Coronary artery calcification and its progression: what does it really mean? JACC Cardiovasc Imaging. 2018;11(1):127–42. https://doi.org/10.1016/j.jcmg.2017.10.012 . - DOI

[2] Mori H, Torii S, Kutyna M, Sakamoto A, Finn AV, Virmani R. Coronary artery calcification and its progression: what does it really mean? JACC Cardiovasc Imaging. 2018;11(1):127–42. https://doi.org/10.1016/j.jcmg.2017.10.012 . - DOI

[3] Huisman J, van der Heijden LC, Kok MM, Danse PW, Jessurun GA, Stoel MG, et al. Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: a patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II). Am Heart J. 2016;175:121–9. https://doi.org/10.1016/j.ahj.2016.02.012 . - DOI - PubMed

[4] Huisman J, van der Heijden LC, Kok MM, Danse PW, Jessurun GA, Stoel MG, et al. Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents: a patient-level pooled analysis from TWENTE and DUTCH PEERS (TWENTE II). Am Heart J. 2016;175:121–9. https://doi.org/10.1016/j.ahj.2016.02.012 . - DOI - PubMed

[5] Copeland-Halperin RS, Baber U, Aquino M, Rajamanickam A, Roy S, Hasan C, et al. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: findings from a large multiethnic registry. Catheter Cardiovasc Interv. 2018;91(5):859–66. https://doi.org/10.1002/ccd.27204 . - DOI - PubMed

[6] Copeland-Halperin RS, Baber U, Aquino M, Rajamanickam A, Roy S, Hasan C, et al. Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: findings from a large multiethnic registry. Catheter Cardiovasc Interv. 2018;91(5):859–66. https://doi.org/10.1002/ccd.27204 . - DOI - PubMed

[7] Bourantas CV, Zhang YJ, Garg S, Iqbal J, Valgimigli M, Windecker S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100(15):1158–64. https://doi.org/10.1136/heartjnl-2013-305180 . - DOI - PubMed

[8] Bourantas CV, Zhang YJ, Garg S, Iqbal J, Valgimigli M, Windecker S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100(15):1158–64. https://doi.org/10.1136/heartjnl-2013-305180 . - DOI - PubMed

[9] Wang X, Matsumura M, Mintz GS, Lee T, Zhang W, Cao Y, et al. In vivo calcium detection by comparing optical coherence tomography, intravascular ultrasound, and angiography. JACC Cardiovasc Imaging. 2017;10(8):869–79. https://doi.org/10.1016/j.jcmg.2017.05.014 Intravascular imaging study correlating angiographically visible and invisible calcium with intravascular imaging and their impact on stent expansion. - DOI - PubMed

[10] Wang X, Matsumura M, Mintz GS, Lee T, Zhang W, Cao Y, et al. In vivo calcium detection by comparing optical coherence tomography, intravascular ultrasound, and angiography. JACC Cardiovasc Imaging. 2017;10(8):869–79. https://doi.org/10.1016/j.jcmg.2017.05.014 Intravascular imaging study correlating angiographically visible and invisible calcium with intravascular imaging and their impact on stent expansion. - DOI - PubMed

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Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

Affiliations

Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials