Abstract
Calcific coronary lesions have been associated with multiple complications, including poor response to balloon angioplasty, dissection during PTCA/predilatation, difficulty in stent delivery and inadequate stent expansion [1–4]. This complexity associated with severely calcific lesion intervention has been associated with increase in-hospital (12.3% vs 1.5%) and 1-year MACE (24.2% vs. 5.4%) when compared to lesions with no/mild calcium [5]. Optimal stent delivery and apposition require adequate preparation and modification with super-high pressure noncompliant balloons, cutting balloon atherotomy or atherectomy devices.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bourantas CV, 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.
Copeland-Halperin RS, 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.
Genereux P, et al. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014;63(18):1845–54.
Kahn JK, Hartzler GO. Balloon rupture due to lesion morphology during coronary angioplasty. Catheter Cardiovasc Diagn. 1990;21(2):89–91.
Sharma SK, et al. Impact of calcification on percutaneous coronary intervention: MACE-Trial 1-year results. Catheter Cardiovasc Interv. 2019;94(2):187–94.
Hoffmann R, et al. Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study. Eur Heart J. 1998;19(8):1224–31.
Raja Y, Routledge HC, Doshi SN. A noncompliant, high pressure balloon to manage undilatable coronary lesions. Catheter Cardiovasc Interv. 2010;75(7):1067–73.
Secco GG, et al. Clinical experience with very high-pressure dilatation for resistant coronary lesions. Cardiovasc Revasc Med. 2019;20(12):1083–7.
De Maria GL, Scarsini R, Banning AP. Management of calcific coronary artery lesions: is it time to change our interventional therapeutic approach? JACC Cardiovasc Interv. 2019;12(15):1465–78.
Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy. JACC Cardiovasc Interv. 2014;7(4):345–53.
Sakakura K, et al. The incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed. Catheter Cardiovasc Interv. 2017;89(5):832–40.
Sharma SK, et al. North American expert review of rotational atherectomy. Circ Cardiovasc Interv. 2019;12(5):e007448.
Goldberg SL, Colombo A, Akiyama T. Stent under-expansion refractory to balloon dilatation: a novel solution with excimer laser. J Invasive Cardiol. 1998;10(5):269–73.
Bittl JA. Clinical results with excimer laser coronary angioplasty. Semin Interv Cardiol. 1996;1(2):129–34.
Mintz GS, et al. Mechanisms of lumen enlargement after excimer laser coronary angioplasty. An intravascular ultrasound study. Circulation. 1995;92(12):3408–14.
Fernandez JP, et al. Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions. Euro Intervention. 2013;9(2):243–50.
Ali ZA, et al. Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses: the disrupt CAD II study. Circ Cardiovasc Interv. 2019;12(10):e008434.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Sharma, R., Sharma, S.K. (2021). Severely Calcific Coronary Artery Lesion Interventions. In: Kini, A., Sharma, S.K. (eds) Practical Manual of Interventional Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-68538-6_22
Download citation
DOI: https://doi.org/10.1007/978-3-030-68538-6_22
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-68537-9
Online ISBN: 978-3-030-68538-6
eBook Packages: MedicineMedicine (R0)