Managing calcified coronaries: The bugaboo of percutaneous coronary intervention

Percutaneous coronary intervention of lesions with heavily coronary artery calcium (CAC) still is a challenging subset for interventionists, with incremented risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. With the emergence of many novel devices and technologies, the treatment of such lesions has become increasingly feasible, safe, and predictable. It seems likely that combining enhanced intravascular imaging modalities with conventional or new dedicated tools for the treatment of CAC grants better lesion preparation. This optimizes delivery and deployment of drug-eluting stents translating into improved patient outcomes. In this focused review, we provide a summary of principles, techniques, and contemporary evidence for sundry subsisting and emergent plaque-modifying strategies.