Visualization of coronary artery calcification and its impact on percutaneous coronary intervention procedure (a literature review)
Authors: Hubka V. O. , Vailo Yu. M. , Materukhin A. M. , Makarenkov A. L. 
Published: February 2025

In general, the phenomenon of vascular calcification is quite common and might pose considerable impediments for vascular, cardiovascular and endovascular surgeons, as well as for interventional cardiologists when performing surgical manipulations during the treatment of patients with coronary artery disease (CAD) or peripheral atherosclerosis. A high degree of coronary artery (CA) calcification is independently associated with an increased risk of major cardiovascular events after percutaneous coronary intervention (PCI).
The aim of the work is to analyze modern professional literature, summarize information and add to our ideas about the impact of CA calcification and methods of its visualization on the PCI technical aspects.
Since the second half of the 20th century, various methods that allow for visualization of СA plaque calcification have been developed and introduced into clinical practice. These techniques vary in their potential due to type and technical parameters of the radiation source, possibilities of using specialized software, automation of image analysis, etc. Currently, the methods of intravascular imaging, intravascular ultrasound (IVUS) and optical coherence tomography (OCT), are the most informative for visualization of CA calcification and can help interventionalists when performing PCI to identify and evaluate calcified lesions, to determine the indications and choose an optimal type of device for calcium modification, directing appropriate stent or balloon sizing; to detect signs of suboptimal stent implantation providing control over possible periprocedural complications. In addition, the deposition of such morphological substrate as calcium within coronary atherosclerotic lesions is a predictor of insufficient stent expansion during PCI, which in turn can cause thrombosis and in-stent restenosis. CA lesion preparation before stent implantation involves using specialized angiographic balloons or atherectomy devices. Applying these methods of calcium modification contributes to the compliance of the calcified plaque causing fractures beyond or within the stent, ensures optimal final stent expansion and reduces the risks of possible long-term consequences. Furthermore, other periprocedural difficulties and problems may arise during PCI of calcified CA lesions: increased probability of technical failure due to the impossibility of passing the target lesion with instruments, intimal dissection, wall perforation, distal embolization, etc.
Conclusions. CA calcification is a complex issue for an interventional cardiologist during CA stenting, which certainly complicates the PCI procedure and requires a specialist not only theoretical knowledge, but also practical skills in using a wide range of interventional tools and techniques. There are modern methods of identifying calcified CA lesion and its quantitative assessment. Among them are methods of intravascular visualization – IVUS and OCT, which are used directly in a catheterization laboratory during PCI. They provide the amplest opportunities and the most advanced capabilities for determining the morphological substrate of the affected CA area and allow an interventionist to plan PCI and adjust its real-time implementation at different stages of the procedure. The use of intracoronary imaging methods gives more opportunities to improve PCI outcomes.