Percutaneous coronary intervention in highly calcified stenoses: how do we crack it open?

    Authors

    Keywords

    calcium, coronary artery disease, lesion preparation

    DOI

    https://doi.org/10.15836/ccar2023.60

    Full Text

    Introduction : Highly calcified coronary lesions represent up to 30% of all coronary stenoses, and bring greater risk of complications and recurrent events. Non-compliant, cutting/scoring and super-high pressure balloons, together with debulking devices (rotablation and intravascular lithotripsy) are essential in calcium management. ( 1 ) Patients and Methods : We aimed to investigate changes in patterns of calcium management in a tertiary institution cath-lab from 2018 to 2022. We compared yearly penetration of calcium debulking techniques in one center from 2018 to 2022 among all percutaneous coronary intervention (PCI) in patients with chronic and acute coronary syndromes. Results : Among all patients treated in 2018 and 2019, rotablation was used in 1.7% and 1.5% of all PCI cases, whereas super-high pressure balloons were used in 1.3% and 1.1% of cases for debulking. Non-compliant balloons were used for lesion preparation in 18% of all PCI. In 2021 and 2022, rotablation was used for debulking in only 0.4% of cases, whereas super-high pressure balloons were used in 1.2% of cases, often in combination with rotablation. Also, in 2021 and 2022 intravascular lithotripsy (IVL) was used in 1.4% of all PCI cases for debulking, and non-compliant balloons were used for lesion preparation in 32% of cases. Among all PCI in 2021 and 2022, there was 1 case of failed stent delivery in a tortuous calcified vessel, and 1 case of inadequate stent expansion after IVL that was successfully expanded with a super-high pressure balloon. Conclusion : In cases of highly calcified coronary lesions, IVL has been becoming a standard in crossable lesions, whereas rotablation has been used occasionally - almost exclusively in non-crossable lesions in combination with super-high pressure balloons after successful crossing. Also, routine use of non-compliant ballons for lesion preparation has increased markedly, whereas scoring balloons were not used routinely in calcified lesions.

    Cardiologia Croatica
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    Percutaneous coronary intervention in highly calcified stenoses: how do we crack it open?

    Extended Abstract
    Issue3-4
    Published
    Pages60
    PDF via DOIhttps://doi.org/10.15836/ccar2023.60
    calcium
    coronary artery disease
    lesion preparation

    Authors

    Tomislav Šipić*University Hospital Dubrava, Zagreb, Croatia
    Ivana JurinUniversity Hospital Dubrava, Zagreb, Croatia
    Nikola PavlovićUniversity Hospital Dubrava, Zagreb, Croatia
    Marin PavlovUniversity Hospital Dubrava, Zagreb, Croatia
    Aleksandar BlivajsUniversity Hospital Dubrava, Zagreb, Croatia
    Šime ManolaUniversity Hospital Dubrava, Zagreb, Croatia
    Irzal Hadžibegović*University Hospital Dubrava, Zagreb, Croatia

    Full Text

    Introduction : Highly calcified coronary lesions represent up to 30% of all coronary stenoses, and bring greater risk of complications and recurrent events. Non-compliant, cutting/scoring and super-high pressure balloons, together with debulking devices (rotablation and intravascular lithotripsy) are essential in calcium management. ( 1 ) Patients and Methods : We aimed to investigate changes in patterns of calcium management in a tertiary institution cath-lab from 2018 to 2022. We compared yearly penetration of calcium debulking techniques in one center from 2018 to 2022 among all percutaneous coronary intervention (PCI) in patients with chronic and acute coronary syndromes. Results : Among all patients treated in 2018 and 2019, rotablation was used in 1.7% and 1.5% of all PCI cases, whereas super-high pressure balloons were used in 1.3% and 1.1% of cases for debulking. Non-compliant balloons were used for lesion preparation in 18% of all PCI. In 2021 and 2022, rotablation was used for debulking in only 0.4% of cases, whereas super-high pressure balloons were used in 1.2% of cases, often in combination with rotablation. Also, in 2021 and 2022 intravascular lithotripsy (IVL) was used in 1.4% of all PCI cases for debulking, and non-compliant balloons were used for lesion preparation in 32% of cases. Among all PCI in 2021 and 2022, there was 1 case of failed stent delivery in a tortuous calcified vessel, and 1 case of inadequate stent expansion after IVL that was successfully expanded with a super-high pressure balloon. Conclusion : In cases of highly calcified coronary lesions, IVL has been becoming a standard in crossable lesions, whereas rotablation has been used occasionally - almost exclusively in non-crossable lesions in combination with super-high pressure balloons after successful crossing. Also, routine use of non-compliant ballons for lesion preparation has increased markedly, whereas scoring balloons were not used routinely in calcified lesions.