Optimization strategies for percutaneous coronary intervention in calcified coronary lesions: current evidence and future directions

INTRODUCTION: PCI for severely calcified lesions is still challenging. Calcified lesions are associated with suboptimal results and increased risks of adverse cardiovascular events after PCI. Therefore, optimized strategies for the treatment of calcified lesions are clinically needed. AREAS COVERED: This review summarizes the current evidence on PCI for calcified lesions. It covers pathological features of calcified lesions, the role of intravascular imaging, and the applicability of a variety of lesion preparation devices. In addition, this review discusses the efficacy and limitations of pharmacological therapies for calcified lesions. EXPERT OPINION: . The combination of appropriate devices and intravascular imaging will further improve not only acute procedural success but clinical outcomes after PCI for calcified lesions. However, important challenges remain, including limited calcified lesion-specific evidence, the lack of universally validated optimization criteria, and the absence of a standardized treatment algorithm. Further investigation is warranted to establish practical and evidence-based therapeutic approaches for calcified lesions.