Despite advances in prevention and optimal medical therapy, coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. The management of patients with calcified coronary lesions represents one of the last unmet clinical needs in interventional cardiology. Intracoronary calcification is associated with an increased rate of stent thrombosis and restenosis. Recent advancements in interventional treatment, such as coronary atherectomy devices and intravascular lithotripsy, can facilitate interventions, while intracoronary imaging techniques can optimize results.

Peripheral vessel calcifications have gained renewed attention in recent years. Different arterial calcification patterns have been shown to have distinct risk factors and treatment outcomes, indicating potentially different pathophysiological mechanisms. Heavily calcified lesions can be challenging to dilate adequately with conventional balloons and stents, leading to frequent periprocedural complications and higher rates of target lesion revascularization. High-pressure, non-compliant balloon angioplasty may lack sufficient force to modify calcified lesions fully, and even when successful, may not affect the entire calcified area. Many new balloon devices (scoring, cutting, and lithotripsy balloons) and atherectomy devices (such as excimer laser, rotational, and orbital atherectomy) are now available to address this issue. Intravascular imaging also has a potential advantage in optimizing outcomes.

Transcatheter aortic valve implantation via femoral artery access is now an established therapy for elderly patients with symptomatic severe aortic valve stenosis.. The primary limitation of transfemoral access is intravascular calcification, but new calcium modification treatments such as atherectomy and intravascular lithotripsy can facilitate sheath insertion.

The goals of this Research Topic are to:

1. Identify the most reasonable management strategies for patients with calcified stenoses.

2. Present short- and long-term outcomes of coronary and peripheral calcium debulking strategies such as rotational and orbital atherectomy, laser atherectomy, and IVL.

3. Demonstrate how to use intravascular imaging during interventions in calcified vessels.

4. Demonstrate how to facilitate difficult transfemoral access during TAVI procedures

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Frontiers in Cardiovascular Medicine

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