Abstract
Coronary calcification often complicates atherosclerosis. With an aging population,
coinciding with lower thresholds for coronary angiography and percutaneous coronary
intervention (PCI), severe calcific coronary stenoses remain a challenge for interventional
cardiologists. Although advances in coronary guidewires, percutaneous balloons, and
adjunctive procedural devices have improved success of PCI, recalcitrant calcified
lesions not amenable to the conventional technique frequently occur. Coronary atherectomy
with plaque modification provides a therapeutic alternative. As such, various modalities
such as rotational, orbital or laser atherectomy, and more recently shockwave lithoplasty
have become therapeutic options for PCI. We provide a summary of the principles, technique,
and contemporary evidence for these currently approved devices designed to treat severe
coronary calcific lesions.
Résumé
La calcification coronarienne est une complication courante de l’athérosclérose. Dans
le contexte du vieillissement de la population, parallèlement à une diminution des
seuils d’admissibilité à une coronarographie ou à une intervention coronarienne percutanée
(ICP), les sténoses coronariennes présentant une calcification sévère demeurent un
défi pour les cardiologues interventionnels. Si les avancées réalisées en matière
de fils-guides coronaires, de ballonnets introduits par voie percutanée et de dispositifs
interventionnels d’appoint ont permis d’améliorer les résultats de l’ICP, les lésions
calcifiées récalcitrantes ne pouvant pas être traitées par la technique classique
sont cependant fréquentes. L’athérectomie coronarienne avec modification de la plaque
constitue une solution thérapeutique de rechange. De fait, différentes modalités comme
l’athérectomie rotative, orbitale ou au laser et, plus récemment, la lithoplastie
par ondes de choc, sont devenues des options thérapeutiques pouvant remplacer l’ICP.
Nous présentons une synthèse des principes, des techniques et des données probantes
récentes se rapportant à ces dispositifs déjà homologués, conçus pour traiter les
lésions des artères coronaires présentant une calcification sévère.
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Article info
Publication history
Published online: August 13, 2018
Accepted:
July 25,
2018
Received:
March 15,
2018
Footnotes
See page 1571 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
