Balancing innovation and safety in percutaneous treatment of coronary artery calcification

Coronary artery disease characterized by vascular calcification poses significant challenges in the field of interventional cardiology. Technological innovations over the past decade have expanded the available tools for percutaneous coronary intervention (PCI), shifting the paradigm from simple lesion crossing to sophisticated calcium modification for optimal stent expansion. Although contemporary methods, including ablative, fracturing, and hybrid approaches, are now widely used, they introduce complex decision-making regarding procedural efficacy, safety, and long-term benefits. Intracoronary imaging modalities have further enabled personalized treatment by providing detailed lesion characterization, but the resultant clinical value of these tailored strategies requires further elucidation. Despite an abundance of procedural success in recent studies, gaps persist regarding the translation of acute outcomes into long-term improvements such as sustained vessel patency and reduced adverse cardiac events. The ongoing debate centers on the comparative merit of diverse calcium modification devices and the precise sequencing of therapeutic steps to best match patient and lesion characteristics. Fundamental questions remain about how to maximize procedural success rates while safeguarding against complications such as coronary dissection, perforation, and periprocedural hemodynamic instability.
This Research Topic aims to consolidate current knowledge, spur the development of new evidence, and refine clinical practice in the management of calcified coronary lesions with PCI. By fostering the submission of original research, systematic reviews, technical and imaging-based studies, meta-analyses, and long-term follow-up reports, the goal is to bridge the gap between procedural innovation and patient-centered outcomes. Key objectives include identifying the optimal selection and combination of calcium modification techniques, defining safety benchmarks, and correlating procedural results with robust clinical endpoints.
Research under this Topic will be limited to percutaneous strategies for calcified coronary lesions, emphasizing both technology adoption and clinical outcomes, while explicitly excluding surgical revascularization approaches. To gather further insights in the percutaneous management of coronary calcification, we welcome articles addressing, but not limited to, the following themes:
o Comparative effectiveness of contemporary calcium modification devices and algorithms
o The role and impact of intracoronary imaging in lesion assessment and procedural guidance
o Safety profiles and risk mitigation strategies for periprocedural complications
o Long-term clinical outcomes following PCI for calcified lesions
o Technical advancements, stepwise and hybrid procedural strategies
o Patient and lesion-specific decision-making frameworks
o Integrative analyses linking procedural, imaging, and follow-up data with clinical endpoints
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We welcome original research, randomized and observational studies, systematic reviews, meta-analyses, technical and imaging-based articles, as well as reports on long-term clinical follow-up.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

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Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Curriculum, Instruction, and Pedagogy
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: Calcium modification, percutaneous coronary intervention, calcified coronary lesions, intracoronary imaging, device technology, stent expansion, procedural outcomes, long-term follow-up, clinical endpoints, safety

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