The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions

Abstract

Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven by an increase in restenosis and stent thrombosis. Intracoronary imaging provides a more precise assessment of lesions and is a critical step when deciding whether the lesion needs to be prepared with atherectomy devices. Physiological assessment of lesion significance is an important consideration to avoid unnecessary stenting. This article summarises the current data on the value of intracoronary imaging and functional assessment for coronary calcified lesions and suggests a treatment strategy based on the findings of intracoronary imaging findings.

The Impact of Intracoronary Imaging on PCI Outcomes in Cases Utilising Rotational Atherectomy: An Analysis of 8,417 Rotational Atherectomy Cases from the British Cardiovascular Intervention Society Database

“…is is thought to be related to the large diameter stents whose deployment, expansion, and apposition need to be as perfect as possible to avoid complications such as stent thrombosis [1,26]. Nevertheless, it is likely that intravascular imaging is still very useful with calcified coronary anatomy to enable identification of patterns of calcium (circumferential vs nodular, superficial vs deep) which may guide selection of the most appropriate calcium modification technique (e.g., rotational atherectomy, lithotripsy, or cutting balloons) [4,5]. e major strength of this study is that the BCIS National PCI data set includes >98% of all PCI procedures performed in the United Kingdom, which, therefore, reflects a national, real-world experience that includes high-risk patients encountered in daily interventional practice (who are often excluded from randomized controlled trials).…”

“…This is thought to be related to the large diameter stents whose deployment, expansion, and apposition need to be as perfect as possible to avoid complications such as stent thrombosis [ 1 , 26 ]. Nevertheless, it is likely that intravascular imaging is still very useful with calcified coronary anatomy to enable identification of patterns of calcium (circumferential vs nodular, superficial vs deep) which may guide selection of the most appropriate calcium modification technique (e.g., rotational atherectomy, lithotripsy, or cutting balloons) [ 4 , 5 ].…”

“…is in turn allows operators to decide on the choice of tools and calcium modification strategies to employ [4].…”

“…These include the use of intravascular ultrasound (IVUS) or optical coherence tomography (OCT). Both of these modalities have been shown to be particularly useful in characterising calcified atheromas by providing precise lesion assessment assessing the axial, circumferential, and longitudinal distribution of calcium [ 3 , 4 ]. This in turn allows operators to decide on the choice of tools and calcium modification strategies to employ [ 4 ].…”

“…Both of these modalities have been shown to be particularly useful in characterising calcified atheromas by providing precise lesion assessment assessing the axial, circumferential, and longitudinal distribution of calcium [ 3 , 4 ]. This in turn allows operators to decide on the choice of tools and calcium modification strategies to employ [ 4 ].…”