{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:06:53Z","timestamp":1791223613556,"version":"4.1.0"},"reference-count":95,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Percutaneous coronary intervention (PCI) for thrombotic and heavily calcified coronary artery lesions and occlusions is often hampered by difficulty in wiring the occlusions, restoring antegrade flow, and proceeding to successful stent implantation. Characterization of dynamic anatomical features such as thrombi and the calcium distribution is key to prevent periprocedural complications and long-term adverse events, which are mainly driven by stent underexpansion and malapposition and may prompt in-stent restenosis or stent thrombosis. Therefore, multimodal imaging is a critical step during PCI to better characterize these high-risk lesions and select those in which careful preparation with debulking devices is needed or to guide stent optimization with the aim of improving procedural and long-term clinical outcomes. Hence, obtaining a better understanding of the underlying cause of thrombus formation, imaging the calcium distribution, and thorough planning remain crucial steps in selecting the optimal revascularization strategy for an individual patient. In this review, we summarize current evidence about the prevalence, predictors, and clinical outcomes of \u201chard-rock\u201d thrombotic lesions treated by PCI, focusing on the value of imaging and physiological assessments performed to guide interventions. Furthermore, we provide an overview of cutting-edge technologies with the aim of facilitating the use of such devices according to specific procedural features.<\/jats:p>","DOI":"10.3390\/jcm14030692","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T03:40:17Z","timestamp":1737517217000},"page":"692","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Percutaneous Revascularization of Thrombotic and Calcified Coronary Lesions"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7580-8029","authenticated-orcid":false,"given":"Andrea","family":"Milzi","sequence":"first","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland"},{"name":"Faculty of Biomedical Sciences, University of Italian Switzerland, CH-6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8377-4663","authenticated-orcid":false,"given":"Federico","family":"Simonetto","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Ospedale San Bassiano, 36061 Bassano del Grappa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1083","authenticated-orcid":false,"given":"Antonio","family":"Landi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland"},{"name":"Faculty of Biomedical Sciences, University of Italian Switzerland, CH-6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/j.jcin.2016.06.022","article-title":"Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents: From the Women in Innovation and Drug-Eluting Stents (WIN-DES) Collaboration","volume":"9","author":"Giustino","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.jjcc.2016.06.010","article-title":"Two-year outcome after treatment of severely calcified lesions with newer-generation drug-eluting stents in acute coronary syndromes: A patient-level pooled analysis from TWENTE and DUTCH PEERS","volume":"69","author":"Huisman","year":"2017","journal-title":"J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1002\/ccd.27204","article-title":"Prevalence, correlates, and impact of coronary calcification on adverse events following PCI with newer-generation DES: Findings from a large multiethnic registry","volume":"91","author":"Baber","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1002\/ccd.22347","article-title":"Scanning electron microscopic analysis of different drug eluting stents after failed implantation: From nearly undamaged to major damaged polymers","volume":"75","author":"Wiemer","year":"2010","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1002\/ccd.26000","article-title":"Optical coherence tomography assessment of the mechanistic effects of rotational and orbital atherectomy in severely calcified coronary lesions","volume":"86","author":"Kini","year":"2015","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1161\/01.CIR.91.7.1959","article-title":"Patterns of Calcification in Coronary Artery Disease","volume":"91","author":"Mintz","year":"1995","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/0002-8703(94)90614-9","article-title":"Detection of intralesional calcium by intracoronary ultrasound depends on the histologic pattern","volume":"128","author":"Friedrich","year":"1994","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/S0002-8703(99)70496-5","article-title":"Calcified plaque cross-sectional area in human arteries: Correlation between intravascular ultrasound and undecalcified histology","volume":"137","author":"Kostamaa","year":"1999","journal-title":"Am. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.amjcard.2014.01.423","article-title":"Thrombus burden and myocardial damage during primary percutaneous coronary intervention","volume":"113","author":"Napodano","year":"2014","journal-title":"Am. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/S0002-9149(01)02040-9","article-title":"Influence of coronary thrombus on outcome of percutaneous coronary angioplasty in the current era (the Mayo Clinic experience)","volume":"88","author":"Singh","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e005587","DOI":"10.1161\/CIRCINTERVENTIONS.117.005587","article-title":"Coronary Embolism Among ST-Segment-Elevation Myocardial Infarction Patients: Mechanisms and Management","volume":"11","author":"Popovic","year":"2018","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1845","DOI":"10.1016\/j.jacc.2014.01.034","article-title":"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","volume":"63","author":"Madhavan","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jcin.2018.12.013","article-title":"Calcified Plaques in Patients With Acute Coronary Syndromes","volume":"12","author":"Sugiyama","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3424","DOI":"10.1161\/01.CIR.0000148131.41425.E9","article-title":"Spotty calcification typifies the culprit plaque in patients with acute myocardial infarction: An intravascular ultrasound study","volume":"110","author":"Ehara","year":"2004","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00392-018-1243-1","article-title":"Predictors for target lesion microcalcifications in patients with stable coronary artery disease: An optical coherence tomography study","volume":"107","author":"Reith","year":"2018","journal-title":"Clin. Res. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12933-019-0926-x","article-title":"Intrinsic calcification angle: A novel feature of the vulnerable coronary plaque in patients with type 2 diabetes: An optical coherence tomography study","volume":"18","author":"Reith","year":"2019","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e70035","DOI":"10.1111\/echo.70035","article-title":"Multimodal Intravascular Imaging of the Vulnerable Coronary Plaque","volume":"41","author":"Milzi","year":"2024","journal-title":"Echocardiography"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1136\/heartjnl-2013-305180","article-title":"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","volume":"100","author":"Bourantas","year":"2014","journal-title":"Heart"},{"key":"ref_19","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_20","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jacc.2004.12.066","article-title":"Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: An intravascular ultrasound study","volume":"45","author":"Fujii","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.jcin.2009.01.011","article-title":"A Volumetric Intravascular Ultrasound Comparison of Early Drug-Eluting Stent Thrombosis Versus Restenosis","volume":"2","author":"Liu","year":"2009","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/j.jcin.2009.10.005","article-title":"Impact of Post-Intervention Minimal Stent Area on 9-Month Follow-Up Patency of Paclitaxel-Eluting Stents: An Integrated Intravascular Ultrasound Analysis From the TAXUS IV, V, and VI and TAXUS ATLAS Workhorse, Long Lesion, and Direct Stent Trials","volume":"2","author":"Doi","year":"2009","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.jcin.2010.11.017","article-title":"Usefulness of Rotational Atherectomy in Preventing Polymer Damage of Everolimus-Eluting Stent in Calcified Coronary Artery","volume":"4","author":"Kuriyama","year":"2011","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jconrel.2017.08.037","article-title":"Calcified plaque modification alters local drug delivery in the treatment of peripheral atherosclerosis","volume":"264","author":"Tzafriri","year":"2017","journal-title":"J. Control. Release"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.jcmg.2012.01.023","article-title":"Accelerated In Vivo Thrombin Formation Independently Predicts the Presence and Severity of CT Angiographic Coronary Atherosclerosis","volume":"5","author":"Borissoff","year":"2012","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.jcmg.2011.12.019","article-title":"High Platelet Reactivity on Clopidogrel Therapy Correlates with Increased Coronary Atherosclerosis and Calcification: A Volumetric Intravascular Ultrasound Study","volume":"5","author":"Chirumamilla","year":"2012","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0735-1097(97)00443-9","article-title":"Arterial Calcification and Not Lumen Stenosis Is Highly Correlated with Atherosclerotic Plaque Burden in Humans: A Histologic Study of 723 Coronary Artery Segments Using Nondecalcifying Methodology","volume":"31","author":"Sangiorgi","year":"1998","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.ijcard.2016.12.150","article-title":"Two-year outcomes after percutaneous coronary intervention of calcified lesions with drug-eluting stents","volume":"231","author":"Redfors","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jcmg.2015.02.003","article-title":"Intravascular Imaging of Coronary Calcification and Its Clinical Implications","volume":"8","author":"Mintz","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E262","DOI":"10.1002\/ccd.27375","article-title":"Temporal trends in percutaneous coronary interventions thru the drug eluting stent era: Insights from 18,641 procedures performed over 12-year period","volume":"92","author":"Landes","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_31","first-page":"1465","article-title":"Management of Calcific Coronary Artery Lesions: Is it Time to Change Our Interventional Therapeutic Approach?","volume":"12","author":"Scarsini","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.amjcard.2014.01.423","article-title":"Impact of thrombus burden on myocardial damage in the setting of primary percutaneous coronary intervention","volume":"113","author":"Napodano","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/S0735-1097(01)01175-5","article-title":"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","volume":"37","author":"Mintz","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/ccd.30699","article-title":"Culprit lesion plaque characterization and thrombus grading by high-definition intravascular ultrasound in patients with ST-segment elevation myocardial infarction","volume":"102","author":"Groenland","year":"2023","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.jacc.2011.09.079","article-title":"Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: A report fromthe International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation","volume":"59","author":"Tearney","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1253\/circj.CJ-14-0108","article-title":"Impact of Target Lesion Coronary Calcification on Stent Expansion","volume":"78","author":"Kobayashi","year":"2014","journal-title":"Circ. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"768","DOI":"10.4244\/EIJV6I6A130","article-title":"Assessment of the coronary calcification by optical coherence tomography","volume":"6","author":"Kume","year":"2011","journal-title":"EuroIntervention"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4244\/EIJ-D-16-00139","article-title":"Three-dimensional volumetric assessment of coronary artery calcification in patients with stable coronary artery disease by OCT","volume":"13","author":"Krishnamoorthy","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e000225","DOI":"10.1136\/openhrt-2014-000225","article-title":"Optical coherence tomography versus intravascular ultrasound to evaluate stent implantation in patients with calcific coronary artery disease","volume":"2","author":"Gudmundsdottir","year":"2015","journal-title":"Open Heart"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e2182","DOI":"10.4244\/EIJ-D-17-00962","article-title":"A new optical coherence tomography-based calcium scoring system to predict stent underexpansion","volume":"13","author":"Fujino","year":"2018","journal-title":"EuroIntervention"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e010296","DOI":"10.1161\/CIRCINTERVENTIONS.120.010296","article-title":"Intravascular Ultrasound-Derived Calcium Score to Predict Stent Expansion in Severely Calcified Lesions","volume":"14","author":"Zhang","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"ehae177","DOI":"10.1093\/eurheartj\/ehae177","article-title":"2024 ESC Guidelines for the management of chronic coronary syndromes","volume":"45","author":"Vrints","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.jcmg.2014.11.012","article-title":"Superficial Calcium Fracture After PCI as Assessed by OCT","volume":"8","author":"Kubo","year":"2015","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1002\/ccd.26635","article-title":"Angiographic severity does not correlate with fractional flow reserve in heavily calcified coronary arteries","volume":"89","author":"Johnson","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.ijcard.2015.03.316","article-title":"Potential contribution of virtual histology plaque composition to hemodynamic\u2013morphologic dissociation in patients with non-ST elevation acute coronary syndrome","volume":"187","author":"Aslanger","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.ijcard.2018.08.024","article-title":"Fractional flow reserve in acute coronary syndromes and in stable ischemic heart disease: Clinical implications","volume":"277","author":"Leone","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Milasinovic, D., Nedeljkovic, O., Maksimovic, R., Sobic-Saranovic, D., Dukic, D., Zobenica, V., Jelic, D., Zivkovic, M., Dedovic, V., and Stankovic, S. (2023). Coronary Microcirculation: The Next Frontier in the Management of STEMI. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041602"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1002\/ccd.10332","article-title":"Focus on the infarct-related artery: A thrombus runs through it","volume":"57","author":"Topaz","year":"2002","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"696","DOI":"10.4244\/EIJ-D-17-00473","article-title":"State of the art: Evolving concepts in the treatment of heavily calcified and undilatable coronary stenoses\u2014From debulking to plaque modification, a 40-year-long journey","volume":"13","author":"Barbato","year":"2017","journal-title":"EuroIntervention"},{"key":"ref_51","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_52","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_53","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1002\/ccd.29801","article-title":"Intravascular lithotripsy for treatment of calcific coronary lesions in ST elevation myocardial infarction","volume":"99","author":"Cosgrove","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1161\/01.CIR.98.8.742","article-title":"Activation of Platelets in Platelet-Rich Plasma by Rotablation Is Speed-Dependent and Can Be Inhibited by Abciximab (c7E3 Fab; ReoPro)","volume":"98","author":"Williams","year":"1998","journal-title":"Circulation"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/ccd.30689","article-title":"Drug-coated balloon strategy following orbital atherectomy for calcified coronary artery compared with drug-eluting stent: One-year outcomes and optical coherence tomography assessment","volume":"102","author":"Mitsui","year":"2023","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e915","DOI":"10.4244\/EIJ-D-24-00160","article-title":"Percutaneous coronary intervention for bifurcation coronary lesions using optimised angiographic guidance: The 18th consensus document from the European Bifurcation Club","volume":"20","author":"Burzotta","year":"2024","journal-title":"EuroIntervention"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/S0140-6736(16)30072-1","article-title":"Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER): An open-label, randomised controlled trial","volume":"387","author":"Helqvist","year":"2016","journal-title":"Lancet"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.jacc.2014.02.530","article-title":"A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)","volume":"63","author":"Carrick","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e004838","DOI":"10.1161\/JAHA.116.004838","article-title":"Deferred Versus Immediate Stenting in Patients With ST-Segment Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis","volume":"6","author":"Qiao","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1016\/j.cjca.2018.07.480","article-title":"Deferred vs Immediate Stenting in Primary Percutaneous Coronary Intervention: A Collaborative Meta-analysis of Randomized Trials With Cardiac Magnetic Resonance Imaging Data","volume":"34","author":"Cassese","year":"2018","journal-title":"Can. J. Cardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Socie","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1056\/NEJMoa1308789","article-title":"Thrombus aspiration during ST-segment elevation myocardial infarction","volume":"369","author":"Lagerqvist","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1056\/NEJMoa1415098","article-title":"Randomized Trial of Primary PCI with or without Routine Manual Thrombectomy","volume":"372","author":"Jolly","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1161\/CIRCULATIONAHA.116.025371","article-title":"Thrombus Aspiration in ST-Segment\u2013Elevation Myocardial Infarction","volume":"135","author":"Jolly","year":"2017","journal-title":"Circulation"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1161\/CIRCULATIONAHA.105.551770","article-title":"Devices for Distal Protection During Percutaneous Coronary Revascularization","volume":"113","author":"Mauri","year":"2006","journal-title":"Circulation"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"182","DOI":"10.15420\/icr.2019.17.R1","article-title":"Rotational Atherectomy: A Contemporary Appraisal","volume":"14","author":"Gupta","year":"2019","journal-title":"Interv. Cardiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ijcard.2013.11.018","article-title":"Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy\u2014An analysis of the UK central cardiac audit database","volume":"170","author":"Cockburn","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1002\/ccd.26698","article-title":"The incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed","volume":"89","author":"Sakakura","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Sakakura, K., Taniguchi, Y., Yamamoto, K., Tsukui, T., Jinnouchi, H., Seguchi, M., Wada, H., and Fujita, H. (2021). Modifiable and unmodifiable factors associated with slow flow following rotational atherectomy. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250757"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jjcc.2017.10.012","article-title":"Acute coronary syndrome\u2014Still a valid contraindication to perform rotational atherectomy? Early and one-year outcomes","volume":"71","author":"Zimoch","year":"2018","journal-title":"J. Cardiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.4244\/EIJ-D-15-00485","article-title":"ROTational AThErectomy in acute coronary syndrome: Early and midterm outcomes from a multicentre registry","volume":"12","author":"Iannaccone","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/ccd.27842","article-title":"Feasibility and clinical outcome of rotational atherectomy in patients presenting with an acute coronary syndrome","volume":"93","author":"Allali","year":"2019","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.carrev.2022.02.020","article-title":"Rotational Atherectomy in Acute Coronary Syndrome: A Meta-Analysis","volume":"42","author":"Qaqish","year":"2022","journal-title":"Cardiovasc. Revascularization Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.jcin.2014.01.158","article-title":"Pivotal Trial to Evaluate the Safety and Efficacy of the Orbital Atherectomy System in Treating De Novo, Severely Calcified Coronary Lesions (ORBIT II)","volume":"7","author":"Chambers","year":"2014","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.carrev.2017.05.005","article-title":"Outcomes of patients with myocardial infarction who underwent orbital atherectomy for severely calcified lesions","volume":"18","author":"Lee","year":"2017","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e008434","DOI":"10.1161\/CIRCINTERVENTIONS.119.008434","article-title":"Safety and Effectiveness of Coronary Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Stenoses","volume":"12","author":"Ali","year":"2019","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1016\/j.jacc.2020.09.603","article-title":"Intravascular Lithotripsy for Treatment of Severely Calcified Coronary Artery Disease","volume":"76","author":"Hill","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1253\/circj.CJ-20-1174","article-title":"Intravascular Lithotripsy for Vessel Preparation in Severely Calcified Coronary Arteries Prior to Stent Placement\u2014Primary Outcomes From the Japanese Disrupt CAD IV Study","volume":"85","author":"Saito","year":"2021","journal-title":"Circ. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e009354","DOI":"10.1161\/CIRCINTERVENTIONS.120.009354","article-title":"Calcific Plaque Modification by Acoustic Shock Waves","volume":"14","author":"Patel","year":"2021","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"438","DOI":"10.2459\/JCM.0000000000001625","article-title":"Coronary calcified nodules versus nonnodular coronary calcifications: A systematic review and meta-analysis","volume":"25","author":"Oliveri","year":"2024","journal-title":"J. Cardiovasc. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.carrev.2012.12.008","article-title":"The state of the excimer laser for coronary intervention in the drug-eluting stent era","volume":"14","author":"Badr","year":"2013","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1055\/s-0037-1616537","article-title":"Alterations of Platelet Aggregation Kinetics with Ultraviolet Laser Emission: The \u201cStunned Platelet\u201d Phenomenon","volume":"86","author":"Topaz","year":"2001","journal-title":"Thromb. Haemost."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1586\/17434440.2013.811846","article-title":"Current interventional coronary applications of excimer laser","volume":"10","author":"Fracassi","year":"2013","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.amjcard.2003.11.050","article-title":"Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial)","volume":"93","author":"Topaz","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ijcard.2006.03.024","article-title":"Excimer laser thrombus elimination for prevention of distal embolization and no-reflow in patients with acute ST elevation myocardial infarction: Results from the randomized LaserAMI study","volume":"116","author":"Vogelgesang","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/ccd.20053","article-title":"Novel use of a high-energy excimer laser catheter for calcified and complex coronary artery lesions","volume":"62","author":"Bilodeau","year":"2004","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4244\/EIJV9I2A40","article-title":"Beyond the balloon: Excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions","volume":"9","author":"Fernandez","year":"2013","journal-title":"EuroIntervention"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/S0002-9149(02)02773-X","article-title":"Cutting balloon angioplasty for the prevention of restenosis: Results of the Cutting Balloon Global Randomized Trial","volume":"90","author":"Mauri","year":"2002","journal-title":"Am. J. Cardiol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1536\/ihj.16-605","article-title":"Prolonged Inflation Technique Using a Scoring Balloon for Severe Calcified Lesion","volume":"58","author":"Otsuka","year":"2017","journal-title":"Int. Heart. J."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"e007415","DOI":"10.1161\/CIRCINTERVENTIONS.118.007415","article-title":"High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions","volume":"11","author":"Toelg","year":"2018","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4244\/EIJ-D-23-00811","article-title":"Rotational atherectomy combined with cutting balloon to optimise stent expansion in calcified lesions: The ROTA-CUT randomised trial","volume":"20","author":"Sharma","year":"2024","journal-title":"EuroIntervention"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.4244\/EIJV9I9A188","article-title":"Tools and Techniques Clinical: Percutaneous intervention of calcific coronary lesions","volume":"9","author":"Costopoulos","year":"2014","journal-title":"EuroIntervention"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.carrev.2019.02.026","article-title":"Clinical Experience with Very High-Pressure Dilatation for Resistant Coronary Lesions","volume":"20","author":"Secco","year":"2019","journal-title":"Cardiovasc. Revasc. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"359","DOI":"10.4244\/EIJY15M06_04","article-title":"Very high-pressure dilatation for undilatable coronary lesions: Indications and results with a new dedicated balloon","volume":"12","author":"Secco","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"6456695","DOI":"10.1155\/2023\/6456695","article-title":"Characteristics and Pattern of Calcified Nodule and\/or Nodular Calcification Detected by Intravascular Ultrasound on the Device-Oriented Composite Endpoint (DoCE) in Patients with Heavily Calcified Lesions Who Underwent Rotational Atherectomy-Assisted Percutaneous Coronary Intervention","volume":"2023","author":"Pengchata","year":"2023","journal-title":"J. Intervent. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/692\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:33:24Z","timestamp":1759919604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/692"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":95,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030692"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030692","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]}}}