A Comprehensive Approach to the Management of Severe Coronary Artery Calcification Using Coronary Atherectomy

Review Article

Abstract

Coronary atherosclerosis involves the buildup of plaques in the arteries supplying blood to the heart muscle, leading to conditions like angina and heart attack. Coronary atherectomy, a minimally invasive procedure, aims to modify or remove atherosclerotic plaque, restoring proper blood flow. Various atherectomy techniques (orbital, directional, rotational, laser) use specific instruments to cut, shave, or vaporize plaque, depending on lesion characteristics and patient status. Benefits include improved stent delivery, expansion, and apposition in severely calcified lesions, potentially reducing ischemic complications. The etiology of coronary atherosclerosis is multifactorial, involving lipid accumulation, inflammation, endothelial dysfunction, and vascular remodeling. Diagnosis employs imaging (invasive coronary angiography, CT coronary angiography), analysis of genetic and protein markers (APOE, PCSK9, hs-CRP), and trace element assessment. Understanding atherogenesis mechanisms is crucial for effective prevention and management. The review discusses atherectomy modalities, procedural considerations, clinical implications, disease pathophysiology, and diagnostic approaches