Contemporary management of calcified coronary lesions

Invasive percutaneous treatment of calcified coronary stenoses begins with a careful preparation of the procedure. The operator needs to anticipate possible procedural challenges by assessing the clinical and diagnostic information available. In addition, there is no one-size- fits- all solution, but a successful treatment derives from a combination of tools and techniques. One might rely on algorithms proposed by experienced operators to help in decision-making while building its own experience. Implementation of available imaging techniques both non-invasive and invasive, along with judicious adoption of available tools and techniques, is key to a successful treatment of this challenging lesion setting. The bottom line is to gain sufficient confidence to manage the hardest coronary lesion at the lowest risk of complication for the patient..