Abstract
The performance of percutaneous coronary interventions in the treatment of complex coronary lesions encompasses meticulous imaging analysis and careful selection of revascularization technologies. The response of lesions and vessels to standard angioplasty/stenting treatment is frequently hampered by resistance that exerts deleterious impact on the immediate and long-term results alike. The role of the lesion composition, predominantly the presence of calcification and fibrosis, and its implication on vessel preparation strategy are discussed. Then, the usefulness of various contemporary intravascular imaging modalities in the facilitation of lesion and vessel preparation is presented followed by delineation of preparation strategies as tailored for specific lesion subtypes. The revascularization task involves a careful match of select debulking tool[s] for lesion and vessel revascularization. This approach contributes to the efficacy and safety of procedures and facilitates the final step of coronary interventions that consists of stent deployment and optimal stent struts apposition.
Altogether, the detailed lesion and vessel preparation processes as described in this chapter aim to optimize acute procedural results and improve long-term clinical outcomes in percutaneous coronary revascularization.