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Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification

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Abstract

The concept of lifetime management has not been discussed in the field of percutaneous coronary intervention (PCI), because the durability of drug-eluting stent (DES) is considered to be long enough for most patients. Furthermore, even if in-stent restenosis occurs, the treatment for in-stent restenosis is simple in most cases. On the other hand, the long-term clinical outcomes after DES implantation are worse in severely calcified coronary lesions than in non-calcified lesions. Moreover, the treatment for in-stent calcified restenosis or restenosis due to stent underexpansion is not simple. The concept of lifetime management of severely calcified lesions may be necessary like that of aortic stenosis. Recently, several algorithms have been published in PCI to severely calcified lesions, partly because of the emergence of IVL. These algorithms focus on the selection of cracking and debulking devices for the preparation of stenting. However, the optimal stent expansion does not guarantee the long-term patency, when the target lesion includes calcified nodules. Stent restenosis due to calcified nodules is difficult to manage. In this review article, we propose the algorithm for severely calcified lesions focused on the shape of calcification. We do not need to hesitate stenting when multiple cracks on circumferential calcification are observed by intravascular imaging devices. However, DCB may be an option as final device in some situations, when lifetime management of severely calcified lesions is considered.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan

    Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Kei Yamamoto & Hideo Fujita

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  1. Kenichi Sakakura
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  2. Hiroyuki Jinnouchi
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  3. Yousuke Taniguchi
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  4. Kei Yamamoto
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Correspondence to Kenichi Sakakura.

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Conflict of interest

Dr. Sakakura has received speaking honoraria from Abbott Vascular, Boston Scientific, Nipro, and Terumo. Dr. Sakakura has served as a proctor for Rotablator for Boston Scientific. Dr. Sakakura has served as a consultant for Boston Scientific. Dr. Jinnouchi has received speaking honoraria from Boston Scientific, Nipro, and Terumo. Dr. Yamamoto has received speaking honoraria from Abbott Vascular and Boston Scientific. Dr. Yamamoto has served as a consultant for Boston Scientific.

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Sakakura, K., Jinnouchi, H., Taniguchi, Y. et al. Lifetime management of severely calcified coronary lesions: the treatment algorithm focused on the shape of calcification. Cardiovasc Interv and Ther 38, 375–380 (2023). https://doi.org/10.1007/s12928-023-00950-x

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