Calcific lesions: a growing risk
Over 30% of patients treated for PCI in the United States have some degree of calcium, a 31% increase over the last two decades.¹ Calcium can make it difficult to dilate the artery, leading to complications such as dissection, inadequate stent expansion, and stent malapposition. Patients with moderate to severe calcium have a significantly higher risk of complications, including:
The solution: a simplified approach
The Calcium Lesion Modification Strategy is a simplified and highly effective approach to modifying calcific lesions. Based on proven research and clinical evidence, and vetted by expert interventional cardiologists, the CLMS is built on three key components shared by successful calcium algorithms:
The Calcium Lesion Modification Strategy (CLMS)⁷
A step-by-step guide.
1. See if the device passes. If the device does not pass, treat with rotational atherectomy. If the device passes or the vessel is undilatable (1:1 size), begin to IVUS.
2. Conduct an IVUS pre-assessment. Measure: lesion location (ostial; establish lesion length and define landing zones), plaque morphology (arc: <270° vs. >270°; extent of disease: focal vs. diffuse), and vessel size MLD (<2mm vs. > 2mm).
3. Modify calcific lesion. If larger MLD device delivers eccentric arc <180°: modify calcium with a Cutting Balloon, if a smaller MLD ostial/diffuse preferred concentric arc >270°: modify calcium with Rotational Atherectomy; if a larger MLD ostial/focal preferred concentric arc >270°: modify calcium with Intravascular Lithotripsy.
1. Généreux, P. et al. J Am Coll Cardiol 2014 May;63(18):1845-1854.
2. Dehmer WJ, et al. Circulation. 2010 Jun 14;121(23):2547-55. doi: 10.1161/CIRCULATIONAHA.109.854509.
3. Gilutz H, et al. Cathet Cardiovasc Intervent. 2000;50:212-214.
4. Moussa I, et al. Circulation. 1997;96(1):128-136.
5. Nakano M, et al. Eur Heart J. 2013 Jul 3. Case study results are not predictive of results in other cases. Results in other cases may vary.
6. Nakano M, et al. Eur Heart J. 2013 Jul 3.
7. Adapted from Calcium Algorithm presented by Simon Walsh, MD, Boston
Case study results are not predictive of results in other cases. Results in other cases may vary.
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