Management of severely calcified lesions -Intravascular imaging-guided percutaneous coronary intervention-

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2026-10-01 Epub Date: 2026-04-15 DOI:10.1016/j.jjcc.2026.04.005

Hiroyuki Jinnouchi MD, Kenichi Sakakura MD, Yusuke Watanabe MD, Takunori Tsukui MD, Masaru Seguchi MD, Shun Ishibashi MD, Masashi Hatori MD, Taku Kasahara MD, Kei Yamamoto MD, Yousuke Taniguchi MD, Hideo Fujita MD, FJCC

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The management of these complex lesions continues to require careful procedural planning. Intravascular imaging (IVI), including intravascular ultrasound and optical coherence tomography/optical frequency domain imaging, provides detailed insights into coronary calcium morphology. IVI has become an important tool in contemporary PCI. IVI allows comprehensive evaluation of calcium characteristics such as arc, longitudinal length, thickness, depth, and surface morphology. These findings are closely related to lesion compliance and subsequent stent expansion. The information from IVI facilitates appropriate selection and optimization of calcium modification strategies, including conventional balloons, atherectomy devices, and intravascular lithotripsy. Furthermore, IVI enables assessment of procedural effectiveness by confirming plaque modification, calcium fracture, and stent expansion, while also identifying imaging features associated with an increased risk of vessel injury, dissection, or slow flow. However, each imaging modality has inherent limitations, and careful interpretation of imaging findings is essential, particularly in severely calcified lesions. In this review, we summarize current concepts of IVI-based assessment of coronary calcification and discuss practical considerations for device selection and lesion preparation in severely calcified lesions. 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引用次数: 0

Abstract

•
Intravascular imaging enables detailed assessment of coronary calcium morphology.
•
Calcium characteristics strongly influence lesion preparation and luminal gain.
•
Distinguishing sheet calcification from calcified nodules informs device choice.
•
Effects of balloon, RA, OA, and IVL should be assessed based on IVI findings.
•
Imaging-guided PCI may improve safety and outcomes in severely calcified lesions.

Percutaneous coronary intervention (PCI) for severely calcified coronary lesions remains challenging, as extensive calcification frequently hampers adequate lesion preparation and optimal stent expansion, thereby increasing the risk of procedural complications and adverse clinical outcomes. The management of these complex lesions continues to require careful procedural planning. Intravascular imaging (IVI), including intravascular ultrasound and optical coherence tomography/optical frequency domain imaging, provides detailed insights into coronary calcium morphology. IVI has become an important tool in contemporary PCI. IVI allows comprehensive evaluation of calcium characteristics such as arc, longitudinal length, thickness, depth, and surface morphology. These findings are closely related to lesion compliance and subsequent stent expansion. The information from IVI facilitates appropriate selection and optimization of calcium modification strategies, including conventional balloons, atherectomy devices, and intravascular lithotripsy. Furthermore, IVI enables assessment of procedural effectiveness by confirming plaque modification, calcium fracture, and stent expansion, while also identifying imaging features associated with an increased risk of vessel injury, dissection, or slow flow. However, each imaging modality has inherent limitations, and careful interpretation of imaging findings is essential, particularly in severely calcified lesions. In this review, we summarize current concepts of IVI-based assessment of coronary calcification and discuss practical considerations for device selection and lesion preparation in severely calcified lesions. Integrating intravascular imaging into PCI may contribute to more tailored treatment strategies and improved clinical outcomes in patients with severely calcified coronary artery disease.

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查看原文本刊更多论文

严重钙化病变的处理-血管内成像引导下经皮冠状动脉介入治疗。

经皮冠状动脉介入治疗（PCI）对于严重钙化的冠状动脉病变仍然具有挑战性，因为广泛的钙化经常阻碍充分的病变准备和最佳的支架扩张，从而增加了手术并发症和不良临床结果的风险。这些复杂病变的处理仍然需要仔细的程序规划。血管内成像（IVI），包括血管内超声和光学相干断层扫描/光学频域成像，提供了冠状动脉钙形态的详细信息。IVI已成为当代PCI的重要工具。IVI允许全面评估钙的特性，如弧度、纵向长度、厚度、深度和表面形态。这些发现与病变顺应性和随后的支架扩张密切相关。来自IVI的信息有助于适当选择和优化钙修饰策略，包括传统的球囊、动脉粥样硬化切除术装置和血管内碎石术。此外，IVI可以通过确认斑块修饰、钙断裂和支架扩张来评估手术的有效性，同时也可以识别与血管损伤、夹层或血流缓慢风险增加相关的影像学特征。然而，每种成像方式都有其固有的局限性，仔细解释成像结果是必要的，特别是在严重钙化的病变中。在这篇综述中，我们总结了目前基于ivi的冠状动脉钙化评估的概念，并讨论了在严重钙化病变中设备选择和病变准备的实际考虑。将血管内成像纳入PCI可能有助于更有针对性的治疗策略，并改善严重钙化冠状动脉疾病患者的临床结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.