Calcium Modification Techniques in Complex Percutaneous Coronary Intervention

Shah, Mohammed; Najam, Osman; Bhindi, Ravinay; Silva, Kalpa De

doi:10.1161/circinterventions.120.009870

Cited by 36 publications

(36 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An OCT-based calcium score of ≥4 or an IVUS-based calcium score of ≥2 was associated with a significantly higher risk of stent underexpansion and indicates the need for calcium modification [ 34 , 35 ]. Table 2 shows a simplified system to categorize calcified coronary lesion severity into mild/moderate/severe, based on the presence of high-risk features on intravascular imaging [ 36 ].…”

Section: Definition and Characterization Of Coronary Calcificationmentioning

confidence: 99%

Contemporary Management of Severely Calcified Coronary Lesions

Angsubhakorn

Kang

Fearon

et al. 2022

JPM

View full text Add to dashboard Cite

Coronary artery calcification is increasingly prevalent in our patient population. It significantly limits the procedural success of percutaneous coronary intervention and is associated with a higher risk of adverse cardiovascular events both in the short-term and long-term. There are several modalities for modifying calcified plaque, such as balloon angioplasty (including specialty balloons), coronary atheroablative therapy (rotational, orbital, and laser atherectomy), and intravascular lithotripsy. We discuss each modality’s relative advantages and disadvantages and the data supporting their use. This review also highlights the importance of intravascular imaging to characterize coronary calcification and presents an algorithm to tailor the calcium modification therapy based on specific coronary lesion characteristics.

show abstract

Section: Definition and Characterization Of Coronary Calcificationmentioning

confidence: 99%

Contemporary Management of Severely Calcified Coronary Lesions

Angsubhakorn

Kang

Fearon

et al. 2022

JPM

View full text Add to dashboard Cite

show abstract

“…Similar algorithms have been proposed for calcified lesions by combining multiple devices and intravascular imaging [1]. Although atherectomy is superior in procedural success in comparison with other technologies, it has not shown a reduction in long-term ischemic events.…”

Section: Clinical Implicationmentioning

confidence: 99%

“…Author details 1 Cardiology Department, Guizhou Provincial People's Hospital, No. 83 East Zhongshan Road, Yunyan District, Guiyang 550002, China.…”

Section: Abbreviationsmentioning

confidence: 99%

“…Severe coronary artery calcification is a major challenge associated with higher complication rates and worse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) [1]. In the past decades, technologies have been developed for severely calcified lesions, but there is scarce evidence that one device is superior to the others in improving clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…The PREPARE-CALC (Comparison of Strategies to Prepare Severely Calcified Coronary Lesions) trial reported that the acute lumen gain was not significantly different between the rotational atherectomy (RA) and modified balloons [4]. CB is likely to be an underused and potentially useful adjunct in calcium modification [1]. However, the outcomes in the patients with calcified lesions that were treated by cutting balloons were less studied [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

3-Year outcomes in patients with heavily calcified lesions undergoing percutaneous coronary intervention using cutting balloons

Liu

Yao

Jiang

et al. 2022

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Background Percutaneous coronary intervention (PCI) of heavily calcified lesions (HCLs) is associated with higher complication rates and worse clinical outcomes. Cutting balloon (CB) has been widely used for HCLs, but patients’ prognosis had not been fully clarified. The study aimed to compare 3-year clinical outcomes between patients with HCLs that are treated with CBs and those with non-HCLs. Method Patients who underwent PCI in Guizhou Provincial People’s Hospital from June 2015 to September 2018 were retrospectively included. HCL was defined as radiopaque and high-pressure undilatable lesions. CBs were routinely used in combination with non-compliant balloons for the HCLs. Major adverse cardiac event (MACE) and target vessel failure (TVF) were assessed at 3-year follow-up. Result Among 2432 patients included in the study, 210(8.6%) had HCLs with a procedural success rate of 91.0%. The patients with HCLs had a higher incidence of MACE (23.3% vs. 10.8%, P < 0.001) than those with non-HCLs. By propensity score matching, 172 patients with HCLs were 1:1 paired to those with non-HCLs, and their PCI vessels were exactly matched. The MACE and TVF were significantly higher in the patients with HCLs than those with non-HCLs (MACE: 21.5% vs. 13.4%, P = 0.036; TVF: 19.8% vs. 9.9%, P = 0.008). In the Cox regression analysis, HCL is independently associated with higher risks of MACE [HR: 1.72(1.01–2.94), P = 0.047], TVF [HR: 2.10(1.15–3.81), P = 0.015] and repeat revascularization [HR: 2.20(1.07–4.52), P = 0.032]. Conclusion Patients with HCLs undergoing PCI using CBs in combination with non-compliant balloons had higher risks of complications, procedural failure, and worse clinical outcomes at 3 years than those with non-HCLs.

show abstract

Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Plantes

Scoccia

Neleman

et al. 2023

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure. Aims We aimed to identify optical coherence tomography (OCT)‐derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions. Methods This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre‐PCI OCT was used to assess calcium burden and post‐PCI OCT was used to assess absolute and relative stent expansion. Results A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT‐detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm2 in calcified lesions and 6.24 mm2 in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm2/mm2, 0.52 mm2/mm, and −0.28 mm2/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses. Conclusion Calcium length appeared to be the most important OCT‐derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.

show abstract

Calcium Modification Techniques in Complex Percutaneous Coronary Intervention

Cited by 36 publications

References 66 publications

Contemporary Management of Severely Calcified Coronary Lesions

Contemporary Management of Severely Calcified Coronary Lesions

3-Year outcomes in patients with heavily calcified lesions undergoing percutaneous coronary intervention using cutting balloons

Optical coherence tomography‐derived predictors of stent expansion in calcified lesions

Contact Info

Product

Resources

About