Enfermedad coronaria calcificada: fisiopatología, evaluación por imagen intracoronaria y técnicas de modificación de placa

  1. Angela McInerney 1
  2. Javier Escaned 1
  3. Nieves Gonzalo 1
  1. 1 Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
Revista:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Año de publicación: 2022

Volumen: 4

Número: 3

Páginas: 216-227

Tipo: Artículo

DOI: 10.24875/RECIC.M22000287 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: REC: Interventional Cardiology

Resumen

Las intervenciones coronarias percutáneas en enfermedad arterial coronaria calcificada representan un desafío para el cardiólogo intervencionista. Además, los pacientes con enfermedad arterial coronaria calcificada tienden a tener peores resultados en el seguimiento a corto y largo plazo. La infraexpansión del stent es el resultado más temido cuando se realiza una intervención coronaria percutánea en estos pacientes y es un gran predictor de falla del stent. Por lo tanto, la modificación del calcio guiada por imágenes intracoronarias, es un paso importante en el tratamiento de esta enfermedad. La siguiente revisión describe el uso «paso a paso» de imágenes intracoronarias en la evaluación de la calcificación coronaria y en la selección de una técnica de modificación de calcio adecuada. Además, se describen las técnicas actuales de modificación de calcio disponibles, la evidencia para su uso, su mecanismo de acción y los resultados típicos que se observan en las imágenes intracoronarias.

Referencias bibliográficas

  • 1. Genereux P, Madhavan MV, Mintz GS, et al. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014;63:1845-1854.
  • 2. Fujii K, Carlier SG, Mintz GS, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol. 2005;45:995-998.
  • 3. Hong MK, Mintz GS, Lee CW, et al. Intravascular ultrasound predictors of angiographic restenosis after sirolimus-eluting stent implantation. Eur Heart J. 2006;27:1305-1310.
  • 4. Stefanini GG, Alfonso F, Barbato E, et al. Management of myocardial revascularisation failure: an expert consensus document of the EAPCI. EuroIntervention. 2020;16:e875-e890.
  • 5. Libby P, Buring JE, Badimon L, et al. Atherosclerosis. Nat Rev Dis Primers. 2019;5:56.
  • 6. Mori H, Torii S, Kutyna M, et al. Coronary Artery Calcification and its Progression: What Does it Really Mean? JACC Cardiovasc Imaging. 2018;11:127-142.
  • 7. Bourantas CV, Zhang YJ, Garg S, et al. Prognostic implications of coronary calcification in patients with obstructive coronary artery disease treated by percutaneous coronary intervention: a patient-level pooled analysis of 7 contemporary stent trials. Heart. 2014;100:1158-1164.
  • 8. Madhavan MV, Tarigopula M, Mintz GS, et al. Coronary artery calcification: pathogenesis and prognostic implications. J Am Coll Cardiol. 2014;63:1703-1714.
  • 9. Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res. 2006;99:1044-1059.
  • 10. Kapustin AN, Shanahan CM. Calcium regulation of vascular smooth muscle cell-derived matrix vesicles. Trends Cardiovasc Med. 2012;22:133-137.
  • 11. Alfonso F, Macaya C, Goicolea J, et al. Determinants of coronary compliance in patients with coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol. 1994;23:879-884.
  • 12. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008;358:1336-1345.
  • 13. Vliegenthart R, Oudkerk M, Hofman A, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112:572-577.
  • 14. Motoyama S, Kondo T, Sarai M, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol. 2007;50:319-326.
  • 15. Jin HY, Weir-McCall JR, Leipsic JA, et al. The Relationship Between Coronary Calcification and the Natural History of Coronary Artery Disease. JACC Cardiovasc Imaging. 2021;14:233-242.
  • 16. Kobayashi Y, Okura H, Kume T, et al. Impact of target lesion coronary calcification on stent expansion. Circ J. 2014;78:2209-2214.
  • 17. Genereux P, Madhavan MV, Mintz GS, et al. Relation between coronary calcium and major bleeding after percutaneous coronary intervention in acute coronary syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trials). Am J Cardiol. 2014;113:930-935.
  • 18. Hendry C, Fraser D, Eichhofer J, et al. Coronary Perforación in the drug-eluting stent era: incidence, risk factors, management and outcome: the UK experience. EuroIntervention. 2012;8:79-86.
  • 19. Konigstein M, Madhavan MV, Ben-Yehuda O, et al. Incidence and predictors of target lesion failure in patients undergoing contemporary DES implantation-Individual patient data pooled analysis from 6 randomized controlled trials. Am Heart J. 2019;213:105-111.
  • 20. Guedeney P, Claessen BE, Mehran R, et al. Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation. JACC Cardiovasc Interv. 2020;13:1417-1428.
  • 21. Kawashima H, Serruys PW, Hara H, et al. 10-Year All-Cause Mortality Following Percutaneous or Surgical Revascularization in Patients With Heavy Calcification. JACC Cardiovasc Interv. 2022;15:193-204.
  • 22. Knez A, Becker A, Leber A, et al. Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients. Am J Cardiol. 2004;93:1150-1152.
  • 23. Budoff MJ, Diamond GA, Raggi P, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography. Circulation. 2002;105:1791-1796.
  • 24. Mintz GS, Popma JJ, Pichard AD, et al. Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation. 1995;91:1959-1965.
  • 25. Wang X, Matsumura M, Mintz GS, et al. In Vivo Calcium Detection by Comparing Optical Coherence Tomography, Intravascular Ultrasound, and Angiography. JACC Cardiovasc Imaging. 2017;10:869-879.
  • 26. Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012;59:1058-1072.
  • 27. Raber L, Mintz GS, Koskinas KC, et al. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions. Eur Heart J. 2018;39:3281-3300.
  • 28. Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2001;37:1478-1492.
  • 29. Gao XF, Ge Z, Kong XQ, et al. 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv. 2021;14:247-257.
  • 30. Hong SJ, Mintz GS, Ahn CM, et al. Effect of Intravascular Ultrasound-Guided Drug-Eluting Stent Implantation: 5-Year Follow-Up of the IVUS-XPL Randomized Trial. JACC Cardiovasc Interv. 2020;13:62-71.
  • 31. Kinnaird T, Johnson T, Anderson R, et al. Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database. JACC Cardiovasc Interv. 2020;13:346-357.
  • 32. Mc Inerney A, Escaned J, Gonzalo N. Online Co-Registration Of IVUS and OCT. Minerva Cardiol Angiol. 2021;69:641-654.
  • 33. Pu J, Mintz GS, Biro S, et al. Insights into echo-attenuated plaques, echolucent plaques, and plaques with spotty calcification: novel findings from comparisons among intravascular ultrasound, near-infrared spectroscopy, and pathological histology in 2,294 human coronary artery segments. J Am Coll Cardiol. 2014;63:2220-2233.
  • 34. Kim SW, Mintz GS, Lee WS, et al. DICOM-based intravascular ultrasound signal intensity analysis: an Echoplaque Medical Imaging Bench study. Coron Artery Dis. 2014;25:236-241.
  • 35. Mintz GS. Intravascular imaging of coronary calcification and its clinical implications. JACC Cardiovasc Imaging. 2015;8:461-471.
  • 36. Zhang M, Matsumura M, Usui E, et al. Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions. Circ Cardiovasc Interv. 2021;14:e010296.
  • 37. Fujino A, Mintz GS, Matsumura M, et al. A new optical coherence tomography-based calcium scoring system to predict stent underexpansion. EuroIntervention. 2018;13:e2182-e2189.
  • 38. Ali Z, Price M, Maehara A, Lansky A. New Insights on the Consistency of Coronary IVL Data. Proceedings of Transcatheter Cardiovascular Therapeutics; 2021 05/11/2021. Disponible en: https://tct2021.crfconnect.com/ondemand/world-connect/86455. Consultado 12 Dic 2021.
  • 39. Matsukawa R, Kozai T, Tokutome M, et al. Plaque modification using a cutting balloon is more effective for stenting of heavily calcified lesion than other scoring balloons. Cardiovasc Interv Ther. 2019;34:325-334.
  • 40. Abdel-Wahab M, Toelg R, Byrne RA, et al. High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions. Circ Cardiovasc Interv. 2018;11:e007415.
  • 41. Tang Z, Bai J, Su SP, et al. Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions. J Geriatr Cardiol. 2016;13:984-991.
  • 42. Amemiya K, Yamamoto MH, Maehara A, et al. Effect of cutting balloon after rotational atherectomy in severely calcified coronary artery lesions as assessed by optical coherence tomography. Catheter Cardiovasc Interv. 2019;94:936-944.
  • 43. Secco GG, Buettner A, Parisi R, et al. Clinical Experience with Very High-Pressure Dilatation for Resistant Coronary Lesions. Cardiovasc Revasc Med. 2019;20:1083-1087.
  • 44. Rheude T, Rai H, Richardt G, et al. Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions: the ISAR-CALC randomised trial. EuroIntervention. 2021;17:481-488.
  • 45. Kereiakes DJ, Virmani R, Hokama JY, et al. Principles of Intravascular Lithotripsy for Calcific Plaque Modification. JACC Cardiovasc Interv. 2021;14:1275-1292.
  • 46. Kereiakes DJ, Di Mario C, Riley RF, et al. Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions: Patient-Level Pooled Analysis of the Disrupt CAD Studies. JACC Cardiovasc Interv. 2021;14:1337-1348.
  • 47. Blachutzik F, Honton B, Escaned J, et al. Safety and effectiveness of coronary intravascular lithotripsy in eccentric calcified coronary lesions: a patient-level pooled analysis from the Disrupt CAD I and CAD II Studies. Clin Res Cardiol. 2021;110:228-236.
  • 48. Salazar C, Escaned J, Tirado G, Gonzalo N. Intravascular lithotripsy for recurrent restenosis caused by severe calcific neoatherosclerosis. EuroIntervention. 2020;16:e351-e352.
  • 49. Salazar C, Escaned J, Tirado G, Gonzalo N. Undilatable Calcific Coronary Stenosis Causing Stent Underexpansion and Late Stent Thrombosis: A Complex Scenario Successfully Managed With Intravascular Lithotripsy. JACC Cardiovasc Interv. 2019;12:1510-1512.
  • 50. Yeoh J, Cottens D, Cosgrove C, et al. Management of stent underexpansion using intravascular lithotripsy-Defining the utility of a novel device. Catheter Cardiovasc Interv. 2021;97:22-29.
  • 51. Ali ZA, McEntegart M, Hill JM, Spratt JC. Intravascular lithotripsy for treatment of stent underexpansion secondary to severe coronary calcification. Eur Heart J. 2020;41:485-486.
  • 52. Abdel-Wahab M, Richardt G, Joachim Buttner H, et al. High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: the randomized ROTAXUS (Rotational Atherectomy Prior to Taxus Stent Treatment for Complex Native Coronary Artery Disease) trial. JACC Cardiovasc Interv. 2013;6:10-19.
  • 53. de Waha S, Allali A, Buttner HJ, et al. Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions: Two-year clinical outcome of the randomized ROTAXUS trial. Catheter Cardiovasc Interv. 2016;87:691-700.
  • 54. Hemetsberger R, Gori T, Toelg R, et al. Optical Coherence Tomography Assessment in Patients Treated With Rotational Atherectomy Versus Modified Balloons: PREPARE-CALC OCT. Circ Cardiovasc Interv. 2021;14:e009819.
  • 55. Kaur N, Pruthvi CR, Sharma Y, Gupta H. Rotatripsy: synergistic effects of complementary technologies: a case report. Eur Heart J Case Rep. 2021;5:ytab083.
  • 56. Gonzálvez-García A, Jiménez-Valero S, Galeote G, et al. “RotaTripsy: Combination of rotational atherectomy and intravascular lithotripsy in heavily calcified coronary lesions: A case series”. Cardiovasc Revasc Med. 2022;35:179-184.
  • 57. Parikh K, Chandra P, Choksi N, Khanna P, Chambers J. Safety and feasibility of orbital atherectomy for the treatment of calcified coronary lesions: the ORBIT I trial. Catheter Cardiovasc Interv. 2013;81:1134-1139.
  • 58. Chambers JW, Feldman RL, Himmelstein SI, et al. Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II). JACC Cardiovasc Interv. 2014;7:510-518.
  • 59. Lee M, Genereux P, Shlofmitz R, et al. Orbital atherectomy for treating de novo, severely calcified coronary lesions: 3-year results of the pivotal ORBIT II trial. Cardiovasc Revasc Med. 2017;18:261-264.
  • 60. Redfors B, Sharma SK, Saito S, et al. Novel Micro Crown Orbital Atherectomy for Severe Lesion Calcification: Coronary Orbital Atherectomy System Study (COAST). Circ Cardiovasc Interv. 2020;13:e008993.
  • 61. Kini AS, Vengrenyuk Y, Pena J, et al. Optical coherence tomography assessment of the mechanistic effects of rotational and orbital atherectomy in severely calcified coronary lesions. Catheter Cardiovasc Interv. 2015;86:1024-1032.
  • 62. Goel S, Pasam RT, Chava S, et al. Orbital atherectomy versus rotational atherectomy: A systematic review and meta-analysis. Int J Cardiol. 2020;303:16-21.
  • 63. Bilodeau L, Fretz EB, Taeymans Y, et al. Novel use of a high-energy excimer laser catheter for calcified and complex coronary artery lesions. Catheter Cardiovasc Interv. 2004;62:155-161.
  • 64. Ojeda S, Azzalini L, Suarez de Lezo J, et al. Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry. Catheter Cardiovasc Interv. 2021;98:1241-1249.
  • 65. Lee T, Shlofmitz RA, Song L, et al. The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography. EuroIntervention. 2019;15:e279-e288.
Fuente de los datos: Dialnet