Managing Calcified Coronaries: the Bugaboo of Percutaneous Coronary Intervention

Background Percutaneous coronary intervention (PCI) of lesions with heavily coronary artery calcium (CAC) still represents a challenge for interventionists, with increased risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. In this focused review, we provide the summary of principles, technique and contemporary evidence for various existing and emergent plaque modifying strategies. Main text PCI of lesions with heavy CAC still poses a challenge for the interventionists due to an increased risk of incomplete lesion preparation with subsequent suboptimal stent deployment and higher rates of acute and chronic stent failure. With the emergence of many novel devices and technologies, the treatment of lesions with heavy CAC has become increasingly feasible, safe and predictable. It seems likely that combining enhanced intravascular imaging modalities with traditional or new dedicated tools for the treatment of such lesions grant better lesion preparation. This optimizes delivery and deployment of drug-eluting stents translating into improved patient outcome. Conclusion The lesions with significant CAC are likely to surge due to aging population and increased rates of diabetes and chronic renal disease. The optimal therapy for such lesions is multi-adjunctive and requires the availability of several modalities including intracoronary imaging which could impact the clinical outcome favourably.