Coronary Artherectomy and Treatment of Calcified Coronaries

Abstract

Since the introduction of fi rst balloon angioplasty, the fi eld of interventional cardiology has come a long way and witnessed the development of numerous tools and techniques. However, percutaneous coronary intervention (PCI) of heavily calcifi ed coronary artery lesions has always remained as a challenging scenario as appropriate dilation of these lesions is diffi cult which may lead to inadequate stent deployment and ultimately reduce overall procedural success, increase angiographic complications and subsequent adverse cardiovascular events. Recently, plaque modifi cation using dedicated cutting and scoring balloons and with various atherectomy devices has become progressively more important in the management of severely calcifi ed coronary lesions. It alters the morphology of the lesion and improves the feasibility of PCI in severely calcifi ed coronary lesions with an extremely high success rate and a favorable safety profi le. All available atherectomy devices are characterized with diverse design, diff erent mechanism of plaque modifi cation, and indications. In this review, we will discuss various plaque modifi cation strategies, with a particular focus on current atherectomy devices as they are commonly used for severely calcifi ed coronary lesions.