Distinct Challenges of Eruptive and Non-Eruptive Calcified Nodules in Percutaneous Coronary Intervention.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Cardiology Reports Pub Date : 2024-07-01 Epub Date: 2024-05-29 DOI:10.1007/s11886-024-02075-w
Keyvan Karimi Galougahi, Doosup Shin, Ali Dakroub, Koshiro Sakai, Mandeep Singh, Sarah Malik, Akiko Maehara, Mitsuaki Matsumura, Gary Mintz, James C Spratt, Omar Khalique, Evan Shlofmitz, Allen Jeremias, Richard Shlofmitz, Ziad A Ali
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Abstract

Purpose of review: To provide a summary of prevalence, pathogenesis, and treatment of coronary calcified nodules (CNs).

Recent findings: CNs are most frequently detected at the sites of hinge motion of severely calcified lesions such as in the middle segment of right coronary artery and left main coronary bifurcation. On histopathology, CNs exhibit two distinctive morphologies: eruptive and non-eruptive. Eruptive CNs, which have a disrupted fibrous cap with adherent thrombi, are biologically active. Non-eruptive CNs, which have an intact fibrous cap without thrombi, are biologically inactive, representing either healed eruptive CNs or protrusion of calcium due to plaque progression. Recent studies using optical coherence tomography (OCT) have shown a difference in the mechanism of stent failure in the two subtypes, demonstrating early reappearance of eruptive CNs in the stent (at ~ 6 months) as a unique mechanism of stent failure that does not seem to be preventable by simply achieving adequate stent expansion. The cause of CN reappearance in stent is not known and could be due to acute or subacute intrusion or continued growth of the CN. Whether modification of CN is needed, the most effective calcium modification modality and effectiveness of stent implantation in eruptive CNs has not been elucidated. In this review, we discuss pathogenesis of CNs and how intravascular imaging can help diagnose and manage patients with CNs. We also discuss medical and transcatheter therapies beyond conventional stent implantation for effective treatment of eruptive CNs that warrant testing in prospective studies.

Abstract Image

经皮冠状动脉介入治疗中溃疡性和非溃疡性钙化结节的不同挑战。
综述的目的:概述冠状动脉钙化结节(CNs)的发病率、发病机制和治疗方法:冠状动脉钙化结节最常见于严重钙化病变的铰链运动部位,如右冠状动脉中段和左冠状动脉主干分叉处。在组织病理学上,冠状动脉瘤有两种不同的形态:爆发性和非爆发性。爆发性冠状动脉栓塞的纤维帽破裂,血栓附着,具有生物活性。非爆发性 CN 具有完整的纤维帽,没有血栓,不具有生物活性,代表已愈合的爆发性 CN 或因斑块进展而突出的钙质。最近使用光学相干断层扫描(OCT)进行的研究显示,这两种亚型的支架失效机制不同,早期(约 6 个月时)支架中再次出现糜烂性 CN 是支架失效的一种独特机制,似乎不能通过实现支架的充分扩张来预防。支架中再次出现 CN 的原因尚不清楚,可能是由于 CN 的急性或亚急性侵入或持续生长。是否需要对 CN 进行改造、最有效的钙改造方式以及对爆发性 CN 进行支架植入的有效性尚未阐明。在这篇综述中,我们将讨论 CN 的发病机制以及血管内成像如何帮助诊断和管理 CN 患者。我们还讨论了除传统支架植入以外的医疗和经导管疗法,以有效治疗糜烂性 CNs,这些疗法需要在前瞻性研究中进行测试。
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来源期刊
Current Cardiology Reports
Current Cardiology Reports CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
6.20
自引率
2.70%
发文量
209
期刊介绍: The aim of this journal is to provide timely perspectives from experts on current advances in cardiovascular medicine. We also seek to provide reviews that highlight the most important recently published papers selected from the wealth of available cardiovascular literature. We accomplish this aim by appointing key authorities in major subject areas across the discipline. Section editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research. We also provide commentaries from well-known figures in the field.
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