{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:53:30Z","timestamp":1785840810566,"version":"3.56.0"},"reference-count":84,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Poznan University of Medical Sciences in Poland"},{"id":[{"id":"https:\/\/ror.org\/02zbb2597","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Coronary artery calcification (CAC) is a hallmark of advanced atherosclerosis and a major determinant of procedural complexity during percutaneous coronary intervention (PCI). Once considered a passive consequence of vascular degeneration, CAC is now recognized as an active, highly regulated process driven by inflammation, oxidative stress, extracellular vesicle release, osteogenic differentiation of vascular smooth muscle cells, and biomechanical remodeling. These mechanisms generate a spectrum of calcific phenotypes, ranging from microcalcifications and sheet calcium to nodular calcium and calcified nodules. Calcified nodules represent an advanced fibrocalcific plaque phenotype characterized by fractured calcific plates, luminal calcium protrusion, surface disruption, and variable thrombus formation. They can be characterized using intravascular ultrasound (IVUS), optical coherence tomography (OCT), and hybrid near-infrared spectroscopy\u2013IVUS imaging, and are associated with coronary thrombosis, stent underexpansion, restenosis, target lesion failure, and the need for advanced calcium-modification strategies. A structured literature search of PubMed\/MEDLINE, Web of Science Core Collection, and Scopus identified 83 publications published between 2020 and 2026 for inclusion in the narrative synthesis. This narrative review summarizes the biological and biomechaniclam mechanisms of coronary calcification and calcified nodule formation, compares multimodality intravascular imaging criteria, and discusses contemporary imaging-guided PCI strategies, including balloon-based modification, rotational and orbital atherectomy, excimer laser coronary atherectomy, intravascular lithotripsy, and hybrid approaches. By integrating pathobiology, intravascular imaging criteria, and lesion-specific PCI strategies, this review provides a clinically oriented framework for the assessment and management of calcified nodules. Future directions include standardized imaging definitions, prospectively validated morphology-guided treatment algorithms, and computational and artificial intelligence-assisted plaque characterization.<\/jats:p>","DOI":"10.3390\/ijms27156999","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:38:08Z","timestamp":1785839888000},"page":"6999","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coronary Calcified Nodules: From Pathological Definitions to Intravascular Imaging- and Morphology-Guided PCI"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6788-6067","authenticated-orcid":false,"given":"Mateusz","family":"Lucki","sequence":"first","affiliation":[{"name":"Department and Clinic of Cardiology, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0509-6075","authenticated-orcid":false,"given":"Sylwia","family":"Iwa\u0144czyk","sequence":"additional","affiliation":[{"name":"Department and Clinic of Cardiology, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-2247","authenticated-orcid":false,"given":"Ewa","family":"Lucka","sequence":"additional","affiliation":[{"name":"Clinical Rehabilitation Laboratory, Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-7099","authenticated-orcid":false,"given":"Marek","family":"Grygier","sequence":"additional","affiliation":[{"name":"Department and Clinic of Cardiology, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9309-674X","authenticated-orcid":false,"given":"Przemys\u0142aw","family":"Mitkowski","sequence":"additional","affiliation":[{"name":"Department and Clinic of Cardiology, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2630-5016","authenticated-orcid":false,"given":"Maciej","family":"Lesiak","sequence":"additional","affiliation":[{"name":"Department and Clinic of Cardiology, University of Medical Sciences, 60-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/j.jacc.2023.06.040","article-title":"Association of Coronary Artery Calcium Detected by Routine Ungated CT Imaging with Cardiovascular Outcomes","volume":"82","author":"Peng","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.jcmg.2024.07.024","article-title":"Coronary Artery Calcium Density and Risk of Cardiovascular Events: A Systematic Review and Meta-Analysis","volume":"18","author":"Yong","year":"2025","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_3","first-page":"101259","article-title":"SCAI Expert Consensus Statement on the Management of Calcified Coronary Lesions","volume":"3","author":"Riley","year":"2024","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.jcmg.2024.07.013","article-title":"Relationship between Calcified Plaque Burden, Vascular Inflammation, and Plaque Vulnerability in Patients with Coronary Atherosclerosis","volume":"17","author":"Fujimoto","year":"2024","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4340","DOI":"10.1093\/eurheartj\/ehad342","article-title":"Management Strategies for Heavily Calcified Coronary Stenoses: An EAPCI Clinical Consensus Statement in Collaboration with the EURO4C-PCR Group","volume":"44","author":"Barbato","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/j.jcin.2020.03.053","article-title":"Coronary Calcification and Long-Term Outcomes According to Drug-Eluting Stent Generation","volume":"13","author":"Guedeney","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_7","first-page":"782","article-title":"Coronary Calcification in Patients Presenting with Acute Coronary Syndromes: Insights from the MATRIX Trial","volume":"12","author":"Branca","year":"2023","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ortega, M.A., De Leon-Oliva, D., Gimeno-Longas, M.J., Boaru, D.L., Fraile-Martinez, O., Garc\u00eda-Montero, C., de Castro, A.V., Barrena-Bl\u00e1zquez, S., L\u00f3pez-Gonz\u00e1lez, L., and Amor, S. (2024). Vascular Calcification: Molecular Networking, Pathological Implications and Translational Opportunities. Biomolecules, 14.","DOI":"10.3390\/biom14030275"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Mitsis, A., Khattab, E., Christodoulou, E., Myrianthopoulos, K., Myrianthefs, M., Tzikas, S., Ziakas, A., Fragakis, N., and Kassimis, G. (2024). From Cells to Plaques: The Molecular Pathways of Coronary Artery Calcification and Disease. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216352"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1161\/ATVBAHA.120.314704","article-title":"2020 Jeffrey M. Hoeg Award Lecture: Calcifying Extracellular Vesicles as Building Blocks of Microcalcifications in Cardiovascular Disorders","volume":"41","author":"Aikawa","year":"2021","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1161\/ATVBAHA.122.317332","article-title":"Molecular Mechanisms of Vascular Health: Insights from Vascular Aging and Calcification","volume":"43","author":"Sutton","year":"2023","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Corti, A., De Paolis, A., Grossman, P., Dinh, P.A., Aikawa, E., Weinbaum, S., and Cardoso, L. (2022). The Effect of Plaque Morphology, Material Composition and Microcalcifications on the Risk of Cap Rupture: A Structural Analysis of Vulnerable Atherosclerotic Plaques. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1019917"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e01","DOI":"10.15420\/usc.2021.22","article-title":"Vulnerable Plaque in Patients with Acute Coronary Syndrome: Identification, Importance and Management","volume":"16","author":"Sakamoto","year":"2022","journal-title":"US Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nusca, A., Viscusi, M.M., Piccirillo, F., De Filippis, A., Nenna, A., Spadaccio, C., Nappi, F., Chello, C., Mangiacapra, F., and Grigioni, F. (2022). In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches. Life, 12.","DOI":"10.3390\/life12030393"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s00395-024-01033-5","article-title":"The Interplay of Collagen, Macrophages, and Microcalcification in Atherosclerotic Plaque Cap Rupture Mechanics","volume":"119","author":"Jansen","year":"2024","journal-title":"Basic Res. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"036120","DOI":"10.1063\/5.0168087","article-title":"A Tissue-Engineered Model of the Atherosclerotic Plaque Cap: Toward Understanding the Role of Microcalcifications in Plaque Rupture","volume":"7","author":"Jansen","year":"2023","journal-title":"APL Bioeng."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1016\/j.jacc.2021.02.016","article-title":"Eruptive Calcified Nodules as a Potential Mechanism of Acute Coronary Thrombosis and Sudden Death","volume":"77","author":"Torii","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1161\/CIRCULATIONAHA.123.065657","article-title":"Coronary Artery Calcification: Current Concepts and Clinical Implications","volume":"149","author":"Onnis","year":"2024","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.jcin.2024.12.001","article-title":"A Revised Optical Coherence Tomography-Derived Calcium Score to Predict Stent Underexpansion in Severely Calcified Lesions","volume":"18","author":"Sato","year":"2025","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e02","DOI":"10.15420\/icr.2024.20","article-title":"Calcified Coronary Artery Disease: Pathology, Prevalence, Predictors and Impact on Outcomes","volume":"20","author":"McInerney","year":"2025","journal-title":"Interv. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1007\/s10554-024-03150-7","article-title":"Intravascular Imaging-Guided Percutaneous Coronary Intervention for Heavily Calcified Coronary Lesions: A Systematic Review and Meta-Analysis","volume":"40","author":"Shin","year":"2024","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1016\/j.jacc.2022.11.045","article-title":"Intravascular Imaging during Percutaneous Coronary Intervention: JACC State-of-the-Art Review","volume":"81","author":"Truesdell","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.15420\/icr.2024.01","article-title":"Intracoronary Imaging for Calcium Modification: Intravascular Ultrasound and Optical Coherence Tomography","volume":"20","author":"Shin","year":"2025","journal-title":"Interv. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1038\/s41569-022-00687-9","article-title":"Optical Coherence Tomography in Coronary Atherosclerosis Assessment and Intervention","volume":"19","author":"Araki","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"qyae122","DOI":"10.1093\/ehjimp\/qyae122","article-title":"Image-Guided Percutaneous Revascularization of the Coronary Arteries","volume":"2","author":"Alasnag","year":"2024","journal-title":"Eur. Heart J. Imaging Methods Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1454","DOI":"10.4244\/EIJ-D-24-00282","article-title":"Outcomes of Coronary Intravascular Lithotripsy for the Treatment of Calcified Nodules: A Pooled Analysis of the Disrupt CAD Studies","volume":"20","author":"Ali","year":"2024","journal-title":"EuroIntervention"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1016\/j.jcin.2023.07.010","article-title":"Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Arteries: 2-Year Results\u2014Disrupt CAD III Study","volume":"16","author":"Kereiakes","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wopperer, S.B., Kotronias, R., Marin, F., Benenati, S., Della Mora, F., Portolan, L., Banning, A.P., and De Maria, G.L. (2023). The role of invasive and non-invasive imaging technologies and calcium modification therapies in the evaluation and management of coronary artery calcifications. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1133510"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.pcad.2024.06.007","article-title":"Calcified coronary lesions: Imaging, prognosis, preparation and treatment state of the art review","volume":"86","author":"Power","year":"2024","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s11886-024-02075-w","article-title":"Distinct Challenges of Eruptive and Non-Eruptive Calcified Nodules in Percutaneous Coronary Intervention","volume":"26","author":"Galougahi","year":"2024","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1424","DOI":"10.4244\/EIJ-D-25-00296","article-title":"Identification and treatment of calcified nodules in percutaneous coronary intervention","volume":"21","author":"Ali","year":"2025","journal-title":"EuroIntervention"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/j.recesp.2025.03.003","article-title":"Calcified nodules in the coronary arteries: Systematic review on incidence and percutaneous coronary intervention outcomes","volume":"78","author":"Brilakis","year":"2025","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A Scale for the Quality Assessment of Narrative Review Articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/HCO.0000000000001180","article-title":"Pathophysiology and Clinical Implications of Coronary Artery Calcifications","volume":"39","author":"Saba","year":"2024","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12265-025-10720-0","article-title":"Coronary Artery Calcification: Decoding Mechanisms, Innovations, and Translational Strategies from Bench to Bedside","volume":"19","author":"Ma","year":"2026","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s43556-023-00146-y","article-title":"Vascular Calcification: From the Perspective of Crosstalk","volume":"4","author":"Yang","year":"2023","journal-title":"Mol. Biomed."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1038\/s41586-021-03392-8","article-title":"The Changing Landscape of Atherosclerosis","volume":"592","author":"Libby","year":"2021","journal-title":"Nature"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11883-025-01323-w","article-title":"Cholesterol Crystals as Triggers of NLRP3 Inflammasome Activation in Atherosclerosis","volume":"27","author":"Yalcinkaya","year":"2025","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Neels, J.G., Gollentz, C., and Chinetti, G. (2023). Macrophage Death in Atherosclerosis: Potential Role in Calcification. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1215612"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e18063","DOI":"10.7717\/peerj.18063","article-title":"Key Regulators of Vascular Calcification in Chronic Kidney Disease: Hyperphosphatemia, BMP2, and RUNX2","volume":"12","author":"Liang","year":"2024","journal-title":"PeerJ"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Siracusa, C., Carabetta, N., Morano, M.B., Manica, M., Strangio, A., Sabatino, J., Leo, I., Castagna, A., Cianflone, E., and Torella, D. (2024). Understanding Vascular Calcification in Chronic Kidney Disease: Pathogenesis and Therapeutic Implications. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252313096"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"5712","DOI":"10.1038\/s41598-024-56377-8","article-title":"Role of Klotho and Fibroblast Growth Factor 23 in Arterial Calcification, Thickness, and Stiffness: A Meta-Analysis of Observational Studies","volume":"14","author":"Wungu","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Li, T., Yu, H., Zhang, D., Feng, T., Miao, M., Li, J., and Liu, X. (2022). Matrix Vesicles as a Therapeutic Target for Vascular Calcification. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.825622"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e00017","DOI":"10.1097\/IN9.0000000000000017","article-title":"Mechanisms of Continual Efferocytosis by Macrophages and Its Role in Mitigating Atherosclerosis","volume":"5","author":"Kumar","year":"2023","journal-title":"Immunometabolism"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"105749","DOI":"10.1016\/j.jmbbm.2023.105749","article-title":"Size and Proximity of Micro-Scale Hard-Inclusions Increase the Risk of Rupture in Fibroatheroma-like Laboratory Models","volume":"141","author":"Corti","year":"2023","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"117284","DOI":"10.1016\/j.atherosclerosis.2023.117284","article-title":"Spotty Calcium Deposits within Acute Coronary Syndrome (ACS)-Causing Culprit Lesions Impact Inflammatory Vessel-Wall Interactions and Are Associated with Higher Cardiovascular Event Rates at One Year Follow-Up: Results from the Prospective Translational OPTICO-ACS Study Program","volume":"385","author":"Nelles","year":"2023","journal-title":"Atherosclerosis"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jcmg.2023.08.005","article-title":"High-Risk Plaques on Coronary Computed Tomography Angiography: Correlation with Optical Coherence Tomography","volume":"17","author":"Kinoshita","year":"2024","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e030412","DOI":"10.1161\/JAHA.123.030412","article-title":"Diagnosis and Prognostic Value of the Underlying Cause of Acute Coronary Syndrome in Optical Coherence Tomography-Guided Emergency Percutaneous Coronary Intervention","volume":"12","author":"Kondo","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.jcin.2023.03.009","article-title":"Impact of Eruptive vs. Noneruptive Calcified Nodule Morphology on Acute and Long-Term Outcomes after Stenting","volume":"16","author":"Sato","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lei, F., Yin, Y., Liu, X., Fang, C., Jiang, S., Xu, X., Sun, S., Pei, X., Jia, R., and Tang, C. (2022). Clinical Outcomes of Different Calcified Culprit Plaques in Patients with Acute Coronary Syndrome. J. Clin. Med., 11.","DOI":"10.3390\/jcm11144018"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s11886-025-02243-6","article-title":"Intravascular Coronary Imaging Update: Advances, Clinical Applications, and Future Directions","volume":"27","author":"Waxman","year":"2025","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s12928-025-01096-8","article-title":"Deep Dive into Intravascular Coronary Imaging in Calcified Lesions","volume":"40","author":"Jinnouchi","year":"2025","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s12928-024-01080-8","article-title":"Expert Consensus Statement for Quantitative Measurement and Morphologic Assessment of Optical Coherence Tomography: Update 2025","volume":"40","author":"Fujii","year":"2025","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.tcm.2025.04.004","article-title":"Calcium Modification Techniques in Complex Percutaneous Coronary Intervention: State-of-the-Art Review","volume":"35","author":"Montelaro","year":"2025","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1016\/j.jacc.2026.01.035","article-title":"Intravascular Imaging- vs Angiography-Guided Complex PCI: 5-Year Outcomes from a Randomized Trial","volume":"87","author":"Lee","year":"2026","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1001\/jamacardio.2025.0741","article-title":"OCT vs Angiography for Guidance of Percutaneous Coronary Intervention of Calcified Lesions: The CALIPSO Randomized Clinical Trial","volume":"10","author":"Amabile","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Yang, W., Xu, K., Fu, X., Zhang, W., Hao, Z., Sang, Z., Jiang, L., Qiu, X., Tu, S., and Shen, L. (2025). Lesion-Specific Coronary Artery Calcium Score to Predict Stent Underexpansion. Front. Cardiovasc. Med., 12.","DOI":"10.3389\/fcvm.2025.1524390"},{"key":"ref_58","first-page":"1376","article-title":"Optical Coherence Tomography Detection of Vulnerable Plaques at High Risk of Developing Acute Coronary Syndrome","volume":"22","author":"Kubo","year":"2021","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jacasi.2023.10.001","article-title":"Cardiac Optical Coherence Tomography: History, Current Status, and Perspective","volume":"4","author":"Yonetsu","year":"2024","journal-title":"JACC Asia"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"102167","DOI":"10.1016\/j.jacadv.2025.102167","article-title":"Intravascular Lithotripsy with Optical Coherence Tomography for Severely Calcified Coronary Artery Interventions","volume":"4","author":"Chhikara","year":"2025","journal-title":"JACC Adv."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Usui, E., Mintz, G.S., Hada, M., Lee, T., Hashikata, T., Ishii, H., Schenke, W.H., Waclawiw, M.A., Shishido, K., and Satogami, K. (2022). Predictors of Near-Infrared Spectroscopy-Detected Lipid-Rich Plaque in Coronary Arteries. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.842914"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S0140-6736(21)00249-X","article-title":"Identification of Vulnerable Plaques and Patients by Intracoronary Near-Infrared Spectroscopy and Ultrasound (PROSPECT II): A Prospective Natural History Study","volume":"397","author":"Erlinge","year":"2021","journal-title":"Lancet"},{"key":"ref_63","first-page":"E695","article-title":"Utility of Near-Infrared Spectroscopy to Detect the Extent of Lipid Core Plaque Leading to Periprocedural Myocardial Infarction","volume":"98","author":"Matsuoka","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1016\/j.jcmg.2020.08.030","article-title":"NIRS-IVUS for Differentiating Coronary Plaque Rupture, Erosion, and Calcified Nodule in Acute Myocardial Infarction","volume":"14","author":"Terada","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_65","first-page":"103990","article-title":"Near-Infrared Spectroscopy Detects Lipid-Rich Plaque Preceding ST-Segment Elevation Myocardial Infarction","volume":"4","author":"Mahmood","year":"2025","journal-title":"J. Soc. Cardiovasc. Angiogr. Interv."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/S0140-6736(24)00413-6","article-title":"Preventive Percutaneous Coronary Intervention versus Optimal Medical Therapy Alone for the Treatment of Vulnerable Atherosclerotic Coronary Plaques (PREVENT): A Multicentre, Open-Label, Randomised Controlled Trial","volume":"403","author":"Park","year":"2024","journal-title":"Lancet"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Caiazzo, G., Di Mario, C., Kedhi, E., and De Luca, G. (2023). Current Management of Highly Calcified Coronary Lesions: An Overview of the Current Status. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144844"},{"key":"ref_68","first-page":"145","article-title":"Optical Coherence Tomography versus Intravascular Ultrasound for Culprit Lesion Assessment in Patients with Acute Myocardial Infarction","volume":"16","author":"Mrevlje","year":"2020","journal-title":"Postep. Kardiol. Interwencyjnej"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s12928-025-01233-3","article-title":"Clinical Expert Consensus Document on Rotational Atherectomy from the Japanese Association of Cardiovascular Intervention and Therapeutics: Update 2026","volume":"41","author":"Sakakura","year":"2026","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1016\/S0140-6736(25)00450-7","article-title":"Orbital Atherectomy versus Balloon Angioplasty before Drug-Eluting Stent Implantation in Severely Calcified Lesions Eligible for Both Treatment Strategies (ECLIPSE): A Multicentre, Open-Label, Randomised Trial","volume":"405","author":"Kirtane","year":"2025","journal-title":"Lancet"},{"key":"ref_71","first-page":"e015588","article-title":"Calcium Modification After Orbital Atherectomy and Balloon Angioplasty in Severely Calcified Lesions: The ECLIPSE OCT Substudy","volume":"19","author":"Maehara","year":"2026","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jcin.2024.11.012","article-title":"Rotational Atherectomy, Lithotripsy, or Laser for Calcified Coronary Stenosis: The ROLLER COASTR-EPIC22 Trial","volume":"18","author":"Ojeda","year":"2025","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e011124","DOI":"10.1161\/CIRCINTERVENTIONS.121.011124","article-title":"Impact of Intravascular Ultrasound-Guided Optimal Stent Expansion on 3-Year Hard Clinical Outcomes","volume":"14","author":"Lee","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Angsubhakorn, N., Kang, N., Fearon, C., Techorueangwiwat, C., Swamy, P., Brilakis, E.S., and Bharadwaj, A.S. (2022). Contemporary Management of Severely Calcified Coronary Lesions. J. Pers. Med., 12.","DOI":"10.3390\/jpm12101638"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.15420\/icr.2024.06","article-title":"Dedicated Balloon Techniques for Coronary Calcium Modification","volume":"19","author":"Maffey","year":"2024","journal-title":"Interv. Cardiol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.carrev.2023.02.020","article-title":"Treatment of Calcified Lesions Using a Dedicated Super-High Pressure Balloon: Multicenter Optical Coherence Tomography Registry","volume":"52","author":"Bossard","year":"2023","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Kim, Y., Lee, K., and Her, S.-H. (2025). Clinical Outcomes of Rotational Atherectomy in the Drug-Eluting Stent Era. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072199"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.jcin.2024.03.032","article-title":"Calcified Nodule in Percutaneous Coronary Intervention: Therapeutic Challenges","volume":"17","author":"Shin","year":"2024","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_79","first-page":"1630","article-title":"Clinical Outcomes of Percutaneous Coronary Intervention Using Excimer Laser Coronary Atherectomy for Complex Coronary Lesions: The ACCELERATE Registry","volume":"106","author":"Tomasello","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_80","first-page":"33","article-title":"Excimer Laser Coronary Atherectomy in Severely Calcified Lesions: Time to Bust the Myth","volume":"6","author":"Cobarro","year":"2024","journal-title":"REC Interv. Cardiol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"235","DOI":"10.5603\/cj.96438","article-title":"Coronary Laser with Simultaneous Contrast Injection for the Treatment of Stent Underexpansion","volume":"31","author":"Mohandes","year":"2024","journal-title":"Cardiol. J."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1016\/j.jcin.2021.04.015","article-title":"Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions: Patient-Level Pooled Analysis of the Disrupt CAD Studies","volume":"14","author":"Kereiakes","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Singh, S., Garg, A., Tantry, U.S., Bliden, K., Gurbel, P.A., Kochar, A., Nanna, M.G., and Damluji, A.A. (2025). Combined Atherectomy and Intravascular Lithotripsy in Calcified Coronary Lesions: A Meta-Analysis. J. Invasive Cardiol., 37.","DOI":"10.25270\/jic\/24.00312"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/ehjdh\/ztaf009","article-title":"Examination of the Performance of Machine Learning-Based Automated Coronary Plaque Characterization by Near-Infrared Spectroscopy\u2013Intravascular Ultrasound and Optical Coherence Tomography with Histology","volume":"6","author":"Bajaj","year":"2025","journal-title":"Eur. Heart J. Digit. 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