CARDIOVASCULAR
Advanced management solutions
for calcified lesions
In an ageing and comorbid population with a high incidence of severely calcified coronary
and peripheral lesions, advanced debulking techniques are frequently necessary in order
to offer optimal interventional and endovascular treatment results
Grigorios Korosoglou
MD
Sorin Giusca MD PhD
Department of
Cardiology, Vascular
Medicine and
Pneumology, GRN
Hospital Weinheim,
Weinheim, Germany
Martin Andrassy MD
Fuerst-Stirum Hospital,
Cardiology & Vascular
Medicine, Bruchsal,
Germany
The incidence of coronary, peripheral artery (CAD
and PAD) and cerebrovascular diseases is rising in
the western world, within an ageing population
with comorbidities such as diabetes mellitus,
renal failure and obesity. Despite advances in
pharmacological treatment, many patients with
CAD and PAD require invasive treatment to
reduce the symptoms of angina or claudication,
salvage myocardial or peripheral muscle, and
prevent cardiac death or amputation with
subsequent disability in those presenting with
acute coronary syndromes (ACS) or critical limb
ischaemia (CLI), respectively. For both CAD and
PAD, endovascular techniques are widely accepted
as first-choice treatment options in most patients.
This is attributed to significant technological
advances over the last decades. However, in
patients with severely calcified or/and chronically
totally occluded (CTO) coronary or peripheral
lesions, antegrade wire passage may be difficult
due to the presence of severe calcification in the
area of the proximal cap of the occlusion. In
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addition, even in cases of successful antegrade or
retrograde wire passage, standard interventional
treatment options, such as balloon angioplasty,
drug-coated balloon (DCB) angioplasty and stent
placement may fail. In such cases, advanced
techniques may become necessary for tackling
such complex and calcified lesions. Advanced age,
diabetes mellitus and renal disease, especially
chronic haemodialysis, have all been associated
with increased coronary and peripheral artery
calcification, increasing the need for advanced
endovascular techniques beyond balloon
angioplasty and stent placement in such patients.
Complex and calcified coronary lesions
Despite modern coronary drug-eluting stent (DES)
technologies, calcified coronary lesions remain
a great challenge in interventional cardiology.
Thus, severe and especially concentric
calcification is associated with inadequate balloon
expansion and recoil after balloon angioplasty
and with failure to deliver a stent or with