How should we treat heavily calcified coronary artery disease in contemporary practice? From atherectomy to intravascular lithotripsy.

Kassimis, George and Raina, Tushar and Kontogiannis, Nestoras and Patri, Gopendu and Abramik, Joanna and Zaphiriou, Alex and Banning, Adrian P (2019) How should we treat heavily calcified coronary artery disease in contemporary practice? From atherectomy to intravascular lithotripsy. Cardiovascular revascularization medicine : including molecular interventions. ISSN 1878-0938.

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Abstract

Heavily calcified and densely fibrotic coronary lesions continue to represent a challenge for percutaneous coronary intervention (PCI), as they are difficult to dilate, and it is difficult to deliver and implant drug-eluting stents (DES) properly. Poor stent deployment is associated with high rates of periprocedural complications and suboptimal long-term clinical outcomes. Thanks to the introduction of several adjunctive PCI tools, like cutting and scoring balloons, atherectomy devices, and to the novel intravascular lithotripsy technology, the treatment of such lesions has become increasingly feasible, predictable and safe. A step-wise progression of strategies is described for coronary plaque modification, from well-recognised techniques to techniques that should only be considered when standard manoeuvres have proven unsuccessful. We highlight these techniques in the setting of clinical examples how best to apply them through better patient and lesion selection, with the main objective of optimising DES delivery and implantation, and subsequent improved outcomes.

Item Type: Article
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
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Depositing User: Mrs Semanti Chakraborty
Date Deposited: 28 Feb 2019 09:23
Last Modified: 28 Feb 2019 09:23
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1869

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