Calcified Coronary Lesions Management—A Review of Plaque Modification Methods

Coronary artery disease remains the leading cause of cardiovascular morbidity and mortality worldwide, affecting millions of individuals each year. Coronary artery calcification is a common finding in patients with advanced atherosclerosis and represents an important determinant of procedural success during percutaneous coronary intervention. Severe calcifications are associated with increased procedural complexity and higher complication rates due to challenging lesion preparation, suboptimal stent expansion, and less favorable long-term outcomes. This review summarises the current understanding of vascular calcification mechanisms, diagnostic imaging modalities, and current plaque modification techniques used to optimize procedural results. Methods such as rotational, orbital, and laser atherectomy, as well as specialized balloon technologies and intravascular lithotripsy, are discussed with regard to their mechanisms of action, clinical effectiveness, and safety profiles. Particular emphasis is placed on the integration of advanced imaging for precise lesion assessment, improved patient selection, and the use of combination strategies in complex cases. Finally, emerging technologies and future directions are highlighted, aiming to enhance procedural safety, device deliverability, and treatment outcomes in the evolving field of interventional cardiology.