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Shin D, Karimi Galougahi K, Spratt JC, Maehara A, Collet C, Barbato E, Ribichini FL, Gonzalo N, Sakai K, Mintz GS, Stone GW, Shlofmitz E, Shlofmitz RA, Jeremias A, Ali ZA. Calcified Nodule in Percutaneous Coronary Intervention: Therapeutic Challenges. JACC Cardiovasc Interv 2024; 17:1187-1199. [PMID: 38811101 DOI: 10.1016/j.jcin.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/31/2024]
Abstract
Calcified nodules (CNs) are among the most challenging lesions to treat in contemporary percutaneous coronary intervention. CNs may be divided into 2 subtypes, eruptive and noneruptive, which have distinct histopathological and prognostic features. An eruptive CN is a biologically active lesion with a disrupted fibrous cap and possibly adherent thrombus, whereas a noneruptive CN has an intact fibrous cap and no adherent thrombus. The use of intravascular imaging may allow differentiation between the 2 subtypes, thus potentially guiding treatment strategy. Compared with noneruptive CNs, eruptive CNs are more likely to be deformable, resulting in better stent expansion, but are paradoxically associated with worse clinical outcomes, in part because of their frequent initial presentation as an acute coronary syndrome and subsequent reprotrusion of the CN into the vessel lumen through the stent struts. Pending the results of ongoing studies, a tailored therapeutic approach based on the distinct features of the different CNs may be of value.
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Affiliation(s)
- Doosup Shin
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - James C Spratt
- St. George's, University of London, London, United Kingdom
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Nieves Gonzalo
- Departamento de Cardiología Intervencionista, Hospital Universitario Clínico San Carlos, IdISSC, Universidad Complutense, Madrid, Spain
| | - Koshiro Sakai
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Evan Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Richard A Shlofmitz
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Allen Jeremias
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Ziad A Ali
- Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; New York Institute of Technology, Old Westbury, New York, USA.
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