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Treatment of Calcified Lesions
COR LOE
Recommendations
2a B-R 1. In patients with fibrotic or heavily calcified lesions, plaque
modification with rotational atherectomy can be useful to
improve procedural success.
2b B-NR 2. In patients with fibrotic or heavily calcified lesions, plaque
modification with orbital atherectomy, balloon atherotomy,
laser angioplasty, or intracoronary lithotripsy may be
considered to improve procedural success.
Use of Intravascular Imaging
COR LOE
Recommendations
2a B-R 1. In patients undergoing coronary stent implantation, IVUS
can be useful for procedural guidance, particularly in cases
of left main or complex coronary artery stenting, to reduce
ischemic events.
2a B-R 2. In patients undergoing coronary stent implantation, OCT
is a reasonable alternative to IVUS for procedural guidance,
except in ostial left main disease.
2a C-LD 3. In patients with stent failure, IVUS or OCT is reasonable to
determine the mechanism of stent failure.
Thrombectomy
COR LOE
Recommendation
3: No
benefit
A 1. In patients with STEMI, routine aspiration thrombectomy
before primary PCI is NOT useful.
