Cracking the Culprit Calcium in Coronaries

Abstract

Coronary artery calcium score, which is calculated by computed tomography (CT), is an independent predictor of adverse cardiac events in both symptomatic as well as asymptomatic patients. CT coronary angiography is growingly employed not only to evaluate the vessel stenosis, but also to characterise and quantify the extent and amount of coronary atherosclerosis. The four features of high-risk plaques on CT coronary angiography include napkin-ring sign, low CT attenuation, spotty calcification, and the remarkable positive remodelling. Spotty calcium is closely associated with unstable plaques and acute coronary syndrome. Managing patients with calcified coronaries is a dilemma for the interventional cardiologists. Intravascular imaging, either an IVUS or OCT, is recommended in order to have a meticulous analysis of the severity and characterization of the plaque morphology as coronary angiography alone underestimates calcium and does not easily allow its quantification. Performing percutaneous coronary intervention on a heavily calcified coronary lesion poses several technical challenges. IVL is an up-and-coming new treatment modality for tackling coronary artery calcification. In the foreseeable future, this calcium-modification technique is likely to become the established strategy for dealing with challenging complex, calcified lesions.