Impact of severe lesion calcification on clinical outcome of patients with stable angina, treated with newer generation permanent polymer-coated drug-eluting stents

Section: Discussionsupporting

confidence: 92%

Incidence and predictors of target lesion failure in a multiethnic Asian population receiving the SYNERGY coronary stent: A prospective all‐comers registry

Ananthakrishna

Kristanto

Liu

et al. 2018

“…Hence, it is plausible that the adverse prognosis attributable to severely calcified lesions may be attenuated with widespread use of newer generation DES. However, existing studies evaluating such associations were limited by modest sample size, inclusion of specific clinical syndromes, or randomized trial participants, thereby limiting generalizability to usual clinical practice. Accordingly, we sought to examine the impact of coronary calcium severity on post‐PCI risk in a contemporary and diverse cohort presenting with stable and acute syndromes treated with newer generation DES.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer‐generation DES: Findings from a large multiethnic registry

Copeland‐Halperin

Baber

Aquino

et al. 2017

“…While CAC occurs in various forms and morphologies, the dense intimal atherosclerotic CAC seen in advanced plaques because of inflammation and repeated periods of disruption and healing creates a technical challenge during PCI. The presence of severe CAC is associated with higher rates of major adverse cardiac events (MACE), including death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis .…”

Section: Introductionmentioning

confidence: 99%

Orbital and rotational atherectomy during percutaneous coronary intervention for coronary artery calcification

Lee

Gordin

Stone

et al. 2017

Severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) by inhibiting optimal stent expansion, leading to an increased risk of death, myocardial infarction, repeat revascularization, and stent thrombosis. Coronary atherectomy modifies and debulks calcified plaque to facilitate PCI. Although there is no clear consensus, and further studies are needed, the decision to perform atherectomy should be based upon the presence of fluoroscopic CAC or with the use of intravascular imaging. The management of CAC in the modern era relies on rotational and orbital atherectomy to prepare the lesion to facilitate stent delivery and optimal expansion. While the two technologies differ in equipment, technique, and mechanism of action, the available literature suggests similar efficacy and safety of the two systems, although head-to-head comparisons are limited. While rotational and orbital atherectomy have been shown to have excellent procedural success in terms of facilitating stent delivery, no system has been shown to reduce long-term major adverse cardiovascular events, although the definitive trial for orbital atherectomy has not been completed. Additional trials are needed to find the population who would derive the most benefit of atherectomy and to compare the two systems in a prospective manner.