Q&A
Q.
A higher incidence of perforation with calcific nodules?
A.
Yes most of the coronary perforations during PCI occurs in the calcified nodules largely due to asymmetric expansion of the opposite vessel wall.
Q.
Following AI guidance can be tricky to treat calcified nodules?
A.
AI guidance still needs to perfected before can be fully incorporated in the calcific nodule interventional management.
Currently AI can just help in achieving the final stent expansion.
Q.
What was more useful in today’s case - Rotablator or IVL?
A.
Clearly Rotablator caused the better luminal gain with IVL helping further in causing the calcium fractures.
Q.
How would Orbital Atherectomy have fared in this case?
A.
Orbital atherectomy has slightly better edge over RA in overall efficacy in the treatment of calcific nodules and hence would have fared equally well or even better in today’s case.
Q.
Has laser been tried for treating calcified nodules?
A.
Yes ELCA has been used in treating calcified nodules with very limited efficacy and hence is not recommended.
Q.
We do not have OCT. Can IVUS be used in these cases?
A.
Yes IVUS also can very well diagnose the calcified nodule but sometime difficult to quantify the thickness due to echogenicity of the calcium plate.
Q.
You mentioned incidence of calcific nodules as 25-30%. We do not see that frequently -is it from lack of using imaging?
A.
Yes we are reporting much higher incidence of calcific nodules up to 30% of calcified lesions because of better understanding of the pathology and more ICImaging during PCI.
Q.
Does diagnosing a calcific nodule always require imaging?
A.
Yes calcific nodule can also be diagnosed on plane angiography but in only 5-6% of cases. Accurate diagnosis can only be done by intra-coronary imaging (ICI).
Q.
Why are calcific nodules more in the RCA?
A.
It is postulated that higher calcific nodules in RCA are because of frequent large and ectatic vessels and relatively slow coronary flow.
Q.
Can CTA reliably identify a calcific nodule?
A.
CTA is not reliable to make the diagnosis of calcific nodule as it can only quantify calcium presence rather than thickness of the calcium; a hallmark of calcific nodule. Hence ICI remains the gold standard of making the diagnosis of calcific nodules.
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