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Contemporary management of calcified coronary lesions
  1. Emanuele Barbato1,2
  1. 1 Cardiovascular Research Center, OLV Hospital, Aalst, Belgium
  2. 2 Department of Advanced Biomedical Sciences, Universita degli Studi di Napoli Federico II, Napoli, Italy
  1. Correspondence to Prof. Emanuele Barbato, Cardiovascular Research Center, OLV Hospital, Aalst 9300, Belgium; barba22{at}

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Learning objectives

  • To understand the clinical relevance of calcified coronary lesions.

  • To identify the most reasonable management strategy of patients with calcified stenoses.

  • To learn the tools and techniques facilitating safe percutaneous treatment in this challenging setting.


Management of patients with calcified coronary lesions represents one of the last unmet clinical needs in interventional cardiology. The age of patients referred for invasive coronary angiography with indication to revascularisation is steadily increasing.1 This leads to a higher proportion of patients with complex coronary artery disease (CAD) and with heavily calcified coronary stenosis.2 Beyond the mere epidemiological finding, the presence of calcified coronary stenosis has a significant clinical impact. In fact, the presence of moderate-to-severe calcification portends to increased cardiovascular mortality and major adverse cardiovascular events in patients treated with percutaneous revascularisation.3 4 Severe coronary calcification is an independent predictor of 1-year stent thrombosis and target lesion revascularisation.3 An increased cardiovascular mortality has been reported also for patients with heavily calcified coronary stenosis treated with surgical revascularisation as compared with patients without calcified coronary arteries.5 This can be partly explained by the fact that complete revascularisation is seldom achieved in patients with heavily calcified coronary arteries, given the additional challenge in performing the distal anastomosis of the graft to the target coronary artery.6 Advanced age, the possible association of porcelain aorta and the frequent presence of comorbidities are additional factors considered within the heart team when selecting percutaneous coronary intervention (PCI) as the revascularisation option in these patients. This article, mainly directed to trainees and general cardiologists, focuses on the management of patients with heavily calcified coronary stenoses undergoing PCIs.

Diagnostic challenges of coronary calcifications

One of the first challenges represented by calcified coronary stenosis is that they are often underdiagnosed with routine coronary angiography. Operators report moderate-to-severe calcifications in about 10% of …

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  • Contributors As the sole author, EB confirms that he drafted, reviewed and submitted the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EB declares speaker’s fees from Boston Scientic and Abbott Vascular.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.