Opening the shell for better stent results

Giulio Guagliumi, Kunihiro Shimamura, Vasile Sirbu

Calcification is a hallmark sign of advanced atherosclerosis and increases with age. As age advances, the mean percent calcified area increases for plaques both with moderate and with severe narrowing1. In an autopsy study of patients with severe coronary disease, coronary calcification was present in 90% of men and women aged 50 to 60 and in 100% of men and women older than 602. However, the distribution and magnitude of calcium are distinctly different in atherosclerotic plaques. Calcium can be fragmented or diffuse, different in thickness, arc, and distance from the lumen surface.

Whilst non-invasive coronary computed tomography angiography (CCTA) provides accurate measures of calcium score for more effective risk stratification of interventional procedures3, the detection and quantification of coronary artery calcification in patients undergoing invasive angiography is problematic. Overall, angiography identifies calcium in less than half of the target lesions with ultrasound-detected calcification. In addition, angiography is not reliable for differentiating superficial from deep calcification4. If angiographic calcium is visible in multiple views, the arc of vessel involvement is probably larger.