Challenges With Severe Coronary Artery Calcification in Percutaneous Coronary Intervention: A Narrative Review of Therapeutic Options

Can J Cardiol. 2018 Dec;34(12):1564-1572. doi: 10.1016/j.cjca.2018.07.482. Epub 2018 Aug 14.


Coronary calcification often complicates atherosclerosis. With an aging population, coinciding with lower thresholds for coronary angiography and percutaneous coronary intervention (PCI), severe calcific coronary stenoses remain a challenge for interventional cardiologists. Although advances in coronary guidewires, percutaneous balloons, and adjunctive procedural devices have improved success of PCI, recalcitrant calcified lesions not amenable to the conventional technique frequently occur. Coronary atherectomy with plaque modification provides a therapeutic alternative. As such, various modalities such as rotational, orbital or laser atherectomy, and more recently shockwave lithoplasty have become therapeutic options for PCI. We provide a summary of the principles, technique, and contemporary evidence for these currently approved devices designed to treat severe coronary calcific lesions.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary / methods
  • Atherectomy, Coronary / adverse effects
  • Atherectomy, Coronary / methods
  • Atrioventricular Block / etiology
  • Atrioventricular Block / prevention & control
  • Coronary Artery Disease / therapy*
  • Coronary Restenosis / therapy
  • Humans
  • Lasers, Excimer
  • Lithotripsy
  • No-Reflow Phenomenon
  • Percutaneous Coronary Intervention*
  • Severity of Illness Index
  • Vascular Calcification / therapy*