{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:39:37Z","timestamp":1793144377657,"version":"4.5.0"},"reference-count":56,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":241,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovascular Therapeutics"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction and Objectives<\/jats:title>\n                    <jats:p>Calcified coronary lesions are associated with an increased risk of percutaneous coronary intervention (PCI) failure. Despite the availability of several calcium\u2010modification strategies and randomized trials evaluating their efficacy, comparative investigations remain scanty. The aim of the present analysis is to assess the comparative performance of calcium\u2010modification strategies in patients undergoing PCI of calcified coronary lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic search for randomized trials evaluating calcium\u2010modification strategies in patients undergoing PCI. Random\u2010effects network meta\u2010analyses were performed. The primary outcome was minimal stent area (MSA). Secondary outcomes included all\u2010cause death and stent thrombosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010two trials enrolling 4855 patients were included. Compared to calcium modification with noncompliant balloons, the use of cutting\/scoring balloon (mean difference: 0.81\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      , 95% confidence interval: [0.36, 1.27];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), super high\u2010pressure balloon (SHPB, 0.95\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      [0.18, 1.72];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.016), intravascular lithotripsy (IVL, 0.87\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      [0.40, 1.34];\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), rotational atherectomy (RA, 0.90\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      [0.30, 1.50];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), and RA plus cutting balloon (1.24\u2009mm\n                      <jats:sup>2<\/jats:sup>\n                      [0.46, 2.02];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002) led to larger MSA. According to a network ranking analysis, RA, SHPB, and IVL were possibly the best treatment options in terms of MSA. There were no significant differences in clinical outcomes between calcium\u2010modification strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Compared with standard noncompliant balloons, RA and balloon\u2010based strategies improved the mechanical performance of PCI in calcified coronary lesions. However, this did not result in better clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/cdr\/9434123","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:29:41Z","timestamp":1788154181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Performance of Calcium\u2010Modification Strategies for Coronary Lesions: A Network Meta\u2010Analysis of Randomized Trials"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6897-9807","authenticated-orcid":false,"given":"Fiorenzo","family":"Simonetti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4570-236X","authenticated-orcid":false,"given":"Andreas T.","family":"Kristensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-8486","authenticated-orcid":false,"given":"Tobias","family":"Lenz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1034-6147","authenticated-orcid":false,"given":"Felix","family":"Voll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-8271","authenticated-orcid":false,"given":"Moritz","family":"von Scheidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2971-8310","authenticated-orcid":false,"given":"Michael","family":"Joner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-6080","authenticated-orcid":false,"given":"Tobias","family":"Rheude","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0197-6553","authenticated-orcid":false,"given":"Hendrik","family":"Sager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0728-2819","authenticated-orcid":false,"given":"Erion","family":"Xhepa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4341-891X","authenticated-orcid":false,"given":"Adnan","family":"Kastrati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-5225","authenticated-orcid":false,"given":"Niels Thue","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8668-4313","authenticated-orcid":false,"given":"Salvatore","family":"Cassese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2023.100389"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.01.034"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2020.03.053"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.22347"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.03.038"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_13_7_2","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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