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Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies

  • Interventional Cardiology (SR Bailey and T Helmy, Section Editors)
  • Published:
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Abstract

Purpose of Review

Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions.

Recent Findings

Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion.

Summary

Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.

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Authors and Affiliations

  1. Royal Prince Alfred Hospital, Sydney, Australia

    Keyvan Karimi Galougahi

  2. University of Sydney, Sydney, Australia

    Keyvan Karimi Galougahi

  3. Heart Research Institute, Sydney, Australia

    Keyvan Karimi Galougahi

  4. St. Francis Hospital – The Heart Center, Roslyn, NY, USA

    Evan Shlofmitz, Allen Jeremias, Richard A. Shlofmitz & Ziad A. Ali

  5. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA

    Allen Jeremias, Shawnbir Gogia, Ajay J. Kirtane, Dimitri Karmpaliotis, Gary S. Mintz, Akiko Maehara, Gregg W. Stone & Ziad A. Ali

  6. Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA

    Shawnbir Gogia, Ajay J. Kirtane, Dimitri Karmpaliotis, Akiko Maehara & Ziad A. Ali

  7. Royal Brompton Hospital, London, UK

    Jonathan M. Hill

  8. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Gregg W. Stone

  9. Columbia University Irving Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA

    Ziad A. Ali

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  1. Keyvan Karimi Galougahi
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  2. Evan Shlofmitz
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  3. Allen Jeremias
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Correspondence to Ziad A. Ali.

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Conflict of Interest

Keyvan Karimi Galougahi: none. Evan Shlofmitz: consultant—Abbott Vascular, Opsens Medical. Allen Jeremias: institutional funding (unrestricted education grant) and serves as a consultant for Volcano/Philips and Abbott Vascular; consultant to ACIST Medical and Boston Scientific. Shawnbir Gogia: none. Ajay J. Kirtane: institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting; no speaking/consulting fees were personally received. Personal: travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Jonathan M. Hill: personal fees grants and equity in Shockwave Medical, personal fees and grants from Abbott Vascular, personal fees and grants from Boston Scientific, and personal fees and grants from Abiomed. Dimitri Karmpaliotis: honoraria—Abiomed, Abbott Vascular, Boston Scientific; equity: Saranas, Soundbite, Traverse Vascular. Gary S. Mintz: honoraria—Boston Scientific, Philips, Terumo, and Medtronic. Akiko Maehara: grant support from Abbott Vascular and Boston Scientific, consultant for Conavi Medical Inc. Gregg W. Stone: speaker or other honoraria from Cook, Terumo, QOOL Therapeutics, and Orchestra Biomed; consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, Cardiomech; equity/options from Ancora, QOOL Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, and Valfix. Richard A. Shlofmitz: speaker—Shockwave. Ziad A. Ali: institutional research grants to Columbia University—Abbott, Cardiovascular Systems Inc.; consultant—Abbott, Abiomed, AstraZeneca, Shockwave.

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Karimi Galougahi, K., Shlofmitz, E., Jeremias, A. et al. Therapeutic Approach to Calcified Coronary Lesions: Disruptive Technologies. Curr Cardiol Rep 23, 33 (2021). https://doi.org/10.1007/s11886-021-01458-7

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