Role of intracoronary imaging in severely calcific disease

Abstract

<p>Coronary artery calcium (CAC) poses a major challenge during percutaneous coronary intervention (PCI). The prevalence of significant calcium is reported to be as high as 32%, with higher incidences in the male sex, alongside hypertension, an ST-segment elevation myocardial infarction (STEMI) presentation, and an advancing age. The identification and modification of calcium is important as an association between the presence of CAC and the observation of major adverse cardiovascular events, even in asymptomatic patients. Although angiographically-identified calcium likely reflects the highest burden disease, an inability to assess the calcium, both qualitatively and quantitatively, limits the interventionists in their strategy to achieve an optimal PCI result. Additionally, treating a stent underexpansion in a heavily calcified vessel is more difficult than preventing it. Intra-coronary imaging modalities such as optical coherence tomography (OCT) and intra-vascular ultrasound (IVUS) offer upfront valuable information that may guide the choice of calcium modification tools, evaluate the efficacy of modification/debulking, and permit an optimal stent expansion. Contemporary randomised studies of intra-coronary imaging- vs angiography-guided intervention have demonstrated a clear benefit in adopting an image-guided approach. This review article summarises the value of IVUS and OCT in patients who present with severe calcific diseases.</p>