{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:36:58Z","timestamp":1791358618720,"version":"4.3.1"},"reference-count":76,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Kirk Kerkorian School of Medicine, UNLV, Library Open Article Fund"},{"name":"Kirk Kerkorian School of Medicine, UNLV, Department of Internal Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Calcified coronary lesions remain a challenge in percutaneous coronary intervention (PCI) in both situations of acute myocardial infarction (MI) and stable coronary syndrome. It significantly increases the risk of procedural complications due to difficulty in equipment delivery, balloon expansion, and stent delivery. Furthermore, stent thrombosis, dissection, perforation, and future in-stent restenosis occur more frequently in calcified coronary lesions, impacting repeat target vessel revascularization and increasing the risk of future MI. With intracoronary imaging (intravascular ultrasound and optical coherence tomography), peri-procedural success for treating calcified lesions has increased significantly. Different modalities of calcium modification techniques have since been introduced. This review will discuss the pathophysiology and phenotypes of calcium deposition in the coronary vessels, including eccentric calcified plaques and calcified nodules. We will also focus on calcium modification techniques and their mechanisms: (1) Balloon escalation technique, (2) intravascular lithotripsy, (3) orbital atherectomy, and (4) rotational atherectomy. We will focus on the strengths and limitations of each technique, based on current recommendations and expert consensus from SCAI. We will also provide contemporary evidence of each modality for treating different phenotypes of calcified lesions. In summary, this article provides a comprehensive review of current guidelines for optimizing the treatment of calcified coronary lesions in PCI.<\/jats:p>","DOI":"10.3390\/jcm14228130","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T12:55:31Z","timestamp":1763556931000},"page":"8130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Use of Calcium Modification in Percutaneous Coronary Intervention: A Comprehensive Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0379-3811","authenticated-orcid":false,"given":"Noyan","family":"Ramazani","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0266-2859","authenticated-orcid":false,"given":"Ala W.","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3376-4608","authenticated-orcid":false,"given":"Michael V.","family":"DiCaro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"},{"name":"Department of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divyansh","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7247-2213","authenticated-orcid":false,"given":"Aditi","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3696-195X","authenticated-orcid":false,"given":"KaChon","family":"Lei","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"},{"name":"Department of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV 89119, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1001\/jama.2022.0358","article-title":"Diagnosis and treatment of acute coronary syndromes: A review","volume":"327","author":"Bhatt","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"58","DOI":"10.31083\/j.rcm2402058","article-title":"Timing of complete revascularization in patients with STEMI and multivessel disease: A systematic review and meta-analysis","volume":"24","author":"Panuccio","year":"2023","journal-title":"Rev. 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