Complications of percutaneous coronary interventions in calcified lesions: causes, recognition, management, and how to avoid

Percutaneous coronary interventions (PCIs) are the main stay treatment for patients with atherosclerosis. While plaque debulking and modification is a recognized percutaneous revascularization strategy, the mere presence of coronary artery calcifications serves as a notorious marker of challenging percutaneous interventions. As complications can be encountered during debulking interventions and with awareness of the need to reduce their occurrence, this chapter describes clinical scenarios that can lead to complications during PCI of calcified coronary lesions. Illustrative case examples highlight the aspects of detection, treatment, and device-related complications during PCI of calcified lesions together with recommendations of steps to mitigate and manage them.