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AIMS Medical Science

2024, Volume 11, Issue 3: 292-317. doi: 10.3934/medsci.2024021
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Calcific coronary lesions: management, challenges, and a comprehensive review

  • 1.
    Harbor-UCLA Medical Center Lundquist Institute, Torrance, CA 90502, USA
  • 2.
    David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
  • Received: 12 June 2024 Revised: 11 August 2024 Accepted: 26 August 2024 Published: 09 September 2024

  • As the prevalence of coronary artery disease continues to increase worldwide, understanding the nuances of complex calcific coronary lesions becomes paramount. Coronary artery calcium (CAC) is a well-established, widely available, and highly specific marker of subclinical and advanced atherosclerosis. It remains a vital adjudicator of atherosclerotic cardiovascular disease (ASCVD) and facilitates the up- or down-stratifying of asymptomatic, intermediate risk patients. Notably, the high prevalence of CAC in coronary heart disease (CHD) patients makes the percutaneous treatment of heavily calcified coronary lesions particularly challenging. These cases have a higher risk of immediate complications, late failures due to stent underexpansion or malapposition, and poor clinical outcomes. In this setting, understanding lesion pathophysiology and characterizing calcium deposition with multimodal imaging are crucial steps to improve the successful treatment of these lesions. Therefore, this review explores CAC in the context of complicated and severely calcified lesions. We seek to ameliorate clinical uncertainties and synthesize growing amounts of research to help encourage a homogenous approach to complex calcific coronary lesions. To that end, this comprehensive review paper will first cover epidemiology, pathophysiology, and the types of calcific lesions. Next, we will review acute and long-term complications, as well as lesion preparation and intervention. Last, this review will explore the role of imaging and the contemporary management of severely calcified lesions.

    Citation: Ilana S. Golub, Angela Misic, Lucia P. Schroeder, Jairo Aldana-Bitar, Srikanth Krishnan, Sina Kianoush, Travis Benzing, Keishi Ichikawa, Matthew J. Budoff. Calcific coronary lesions: management, challenges, and a comprehensive review[J]. AIMS Medical Science, 2024, 11(3): 292-317. doi: 10.3934/medsci.2024021

    Related Papers:

  • As the prevalence of coronary artery disease continues to increase worldwide, understanding the nuances of complex calcific coronary lesions becomes paramount. Coronary artery calcium (CAC) is a well-established, widely available, and highly specific marker of subclinical and advanced atherosclerosis. It remains a vital adjudicator of atherosclerotic cardiovascular disease (ASCVD) and facilitates the up- or down-stratifying of asymptomatic, intermediate risk patients. Notably, the high prevalence of CAC in coronary heart disease (CHD) patients makes the percutaneous treatment of heavily calcified coronary lesions particularly challenging. These cases have a higher risk of immediate complications, late failures due to stent underexpansion or malapposition, and poor clinical outcomes. In this setting, understanding lesion pathophysiology and characterizing calcium deposition with multimodal imaging are crucial steps to improve the successful treatment of these lesions. Therefore, this review explores CAC in the context of complicated and severely calcified lesions. We seek to ameliorate clinical uncertainties and synthesize growing amounts of research to help encourage a homogenous approach to complex calcific coronary lesions. To that end, this comprehensive review paper will first cover epidemiology, pathophysiology, and the types of calcific lesions. Next, we will review acute and long-term complications, as well as lesion preparation and intervention. Last, this review will explore the role of imaging and the contemporary management of severely calcified lesions.


    Abbreviations

    CVD

    Cardiovascular disease

         CAC

    Coronary artery calcium

         CTA

    Computed tomography angiography

         ASCVD

    Atherosclerotic cardiovascular disease

         PCI

    Percutaneous coronary intervention

         IVUS

    Intravascular ultrasound

         OCT

    Optical coherence tomography

         NC balloon

    Non-compliant balloon

         IVL

    Intravascular lithotripsy

         RA

    Rotational atherectomy

         OA

    Orbital atherectomy

         ELCA

    Excimer laser coronary atherectomy
    加载中


    Conflict of interest


    The authors declare no conflicts of interest.

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