Calcified coronary lesions

Summary

Heavily calcified vessels represent a challenge for percutaneous coronary intervention (PCI), as they might be associated with stent delivery failure and suboptimal deployment. The mechanisms of vascular calcification are now recognised as complex and highly regulated processes that involve activation of cellular signalling pathways, circulating inhibitors of calcification, genetic factors, and hormones11. Leopold JA. Vascular calcification: Mechanisms of vascular smooth muscle cell calcification. Trends Cardiovasc Med [Internet]. 2015 May;25(4):267–74. Link. To date there are no established interventions to prevent coronary calcification. There are, however, some therapeutic tools which enable PCI in calcified vessels, and these are the focus of this chapter.

Mechanical debulking of atherosclerotic plaques with rotational atherectomy prior to stent placement was originally proposed as a viable strategy to allow PCI in heavily calcified lesions and other challenging lesion settings such as ostial stenosis, diffusely diseased vessels, and chronic total occlusion. Clinical trials have failed to show an improved mortality or even a reduced rate of repeat target lesion revascularisation with mechanical debulking over conventional PCI, thus, in the past, limiting the widespread use of this technique. DES have, however, significantly reduced clinical restenosis (to less than 10% in most cases) and have hence...