Coronary artery calcification (CAC) has posed unique challenges since the advent of percutaneous coronary interventions. CAC may complicate into inability to cross device, acute stent under-expansion, and exfoliation of drug or polymer from stents causing insufficient drug delivery. The calcified plaque deters successful stent implantation until the lesion is adequately prepared. Calcium is an independent risk factor for target lesion revascularization. Various atherectomy tools, such as rotational atherectomy, orbital atherectomy, laser atherectomy, and cutting or scoring balloons, are used in clinical practice. They are designed to increase coronary compliance by mechanically disrupting the calcium. Recently, intravascular lithotripsy (IVL) has been approved by FDA for preparing calcified lesions. It uses shockwave therapy to fracture calcium which facilitates stent delivery and apposition. The use of IVL has increased significantly since its approval. While these calcium modifying tools can be used alone or in combination, atherectomy is usually needed for uncrossable lesions. There are no clinical trials comparing different types of atherectomy and atherectomy with IVL. Moreover, drug-coated balloons are a potential option for calcified plaques. The clinical outcomes of such tools are not well described in special populations and special lesions.
This research topic aims to provide updated techniques for coronary calcium modification. The goal is to explore the safety and efficacy of various calcium-modifying tools, including drug-coated balloons and intravascular lithotripsy, in different clinical scenarios. Specific questions include the comparative effectiveness of different atherectomy devices, the role of IVL in peripheral and structural heart disease, and the outcomes of these interventions in special populations and lesion types.
To gather further insights into the range and limitations of coronary calcium modification techniques, we welcome articles addressing, but not limited to, the following themes:
- The safety and efficacy of drug-coated balloons in calcified coronary plaques
- The use of intravascular lithotripsy in peripheral and structural heart disease
- The use of coronary intravascular lithotripsy in special populations: women, elderly, and in the context of PCI at centers without surgical backup
- The use of coronary intravascular lithotripsy in special lesions: in-stent restenosis, acute coronary syndrome, adjunct therapy to atherectomy
Keywords: Coronary artery calcification, calcified coronary plaques, intravascular lithotripsy, rotational atherectomy, orbital atherectomy, laser atherectomy, cutting balloons, scoring balloons
Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
