Clinical Profile and Intervention Strategies for Resistant Coronary Lesions: A Cross- Sectional Study

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Published Sep 13, 2026
https://doi.org/10.62438/tunismed.v104i08.5025
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Vol. 104 No. 08 (2026): Tunis Med Aug 2026

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Wassim Saoudi
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Slim Abid
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Zied Ben Ameur
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Mohamed Aymen Ben Abdessalem
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Hamza Ellini
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Abdallah Mahdhaoui
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Salem Brahem
Department of Medical Imaging, Farhat Hached University Hospital, Sousse, Tunisia
Imen Bouhlel
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia
Awatef Sassi
Faculty of Medicine of Sousse, Tunisia
Samia Ernez Hajri
Cardiology Department, Farhat Hached University Hospital, Sousse, Tunisia

Abstract

Introduction: Coronary artery disease (CAD) presents significant challenges across various age groups, often resulting in complex coronary lesions that are resistant to conventional treatment approaches. However, data on resistant coronary lesions in this demographic are limited.
Aim: To investigate the population characteristics and protocol for managing patients with resistant coronary lesions.
Methods: This retrospective cross-sectional study included 56 patients of all ages admitted to the cardiology department at the Farhat Hached University Hospital in Sousse between January 2020 and August 2023. Data collection was performed at the patient's bedside by a medical intern, followed by physical examination and blood sampling. Demographic characteristics, cardiovascular risk factors, and treatment modalities for resistant lesions were evaluated.
Results: Fifty-six participants aged 44 to 84 years were included in the study A male predominance was observed (66.0%), with a mean age of 68.7 years. Diabetes (66.0%) and hypertension (80.3%) were the most frequently encountered risk factors, with a higher prevalence in men. Symptom onset was more common in individuals over 65 years old. Angina was the primary reason for consultation, with a predominance of coronary syndromes without ST-segment elevation. The majority of resistant lesions were monotroncular (73%), primarily located in the middle left anterior descending artery. Treatment techniques included the use of modified balloons (44.9%) and ablative techniques (52.1%), with high success rates respectively (84%) and (100%).
Conclusions: This study highlights the importance of cardiovascular risk factors in individuals... (abstract truncated at 250 words).

Keywords:

Calcified coronary lesions, Rotational atherectomy, OPN balloon

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References

  1. Madhavan MV, Tarigopula M, Mintz GS, Maehara A, Stone GW, Généreux P. Coronary artery calcification: pathogenesis
  2. and prognostic implications. J Am Coll Cardiol. 6 mai 2014;63(17):1703-14.
  3. Lo-Kioeng-Shioe MS, Vavere AL, Arbab-Zadeh A, Schuijf JD, Rochitte CE, Chen MY, et al. Coronary Calcium Characteristics as Predictors
  4. of Major Adverse Cardiac Events in Symptomatic Patients: Insights From the CORE320 Multinational Study. JAHA. 19 mars
  5. ;8(6):e007201.
  6. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. A Randomized Comparison of a Sirolimus-Eluting Stent with a Standard Stent for Coronary Revascularization. N Engl J Med. 6 juin 2002;346(23):1773-80.
  7. Sorini Dini C, Nardi G, Ristalli F, Mattesini A, Hamiti B, Di Mario C. Contemporary Approach to Heavily Calcified Coronary Lesions.
  8. Interv Cardiol. nov 2019;14(3):154-63.
  9. Malaiapan Y, Leung M, White AJ. The role of intravascular ultrasound in percutaneous coronary intervention of complex
  10. coronary lesions. Cardiovasc Diagn Ther. oct 2020;10(5):1371-88.
  11. Zimoch WJ, Kubler P, Kosowski M, Tomasiewicz B, Krzysztofik J, Langner A, et al. Patients with acute myocardial infarction and
  12. severe target lesion calcifications undergoing percutaneous coronary intervention have poor long-term prognosis. Kardiol Pol.
  13. ;75(9):859-67.
  14. Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, et al. Coronary morphologic and clinical determinants
  15. of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty
  16. Prognosis Study Group. Circulation. oct 1990;82(4):1193-202.
  17. Goodman WG, London G, Amann K, Block GA, Giachelli C, Hruska KA, et al. Vascular calcification in chronic kidney disease. Am J
  18. Kidney Dis. mars 2004;43(3):572-9.
  19. Mintz GS, Pichard AD, Popma JJ, Kent KM, Satler LF, Bucher TA, et al. Determinants and correlates of target lesion calcium in coronary
  20. artery disease: a clinical, angiographic and intravascular ultrasound study. J Am Coll Cardiol. févr 1997;29(2):268-74.
  21. Nicholls SJ, Tuzcu EM, Wolski K, Sipahi I, Schoenhagen P, Crowe T, et al. Coronary artery calcification and changes in atheroma burden in response to established medical therapies. J Am Coll Cardiol. 16 janv 2007;49(2):263-70.
  22. Johnson RC, Leopold JA, Loscalzo J. Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res. 10
  23. nov 2006;99(10):1044-59.
  24. Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, et al. Coronary artery calcium score and risk
  25. classification for coronary heart disease prediction. JAMA. 28 avr 2010;303(16):1610-6.
  26. Tanenbaum SR, Kondos GT, Veselik KE, Prendergast MR, Brundage BH, Chomka EV. Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. The American Journal of Cardiology. avr 1989;63(12):870-2.
  27. Elias-Smale SE, Proença RV, Koller MT, Kavousi M, van Rooij FJA, Hunink MG, et al. Coronary calcium score improves classification
  28. of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol. 19 oct 2010;56(17):1407-14.
  29. Writing Committee Members, Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, et al. 2010 ACCF/AHA Guideline
  30. for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary: A Report of the American College of Cardiology
  31. Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 21 déc 2010;122(25):2748-64.
  32. Tuzcu EM, Berkalp B, De Franco AC, Ellis SG, Goormastic M, Whitlow PL, et al. The dilemma of diagnosing coronary calcification:
  33. angiography versus intravascular ultrasound. J Am Coll Cardiol. 15 mars 1996;27(4):832-8.
  34. Budoff MJ, Georgiou D, Brody A, Agatston AS, Kennedy J, Wolfkiel C, et al. Ultrafast Computed Tomography as a Diagnostic Modality in the Detection of Coronary Artery Disease: A Multicenter Study. Circulation. mars 1996;93(5):898-904.
  35. Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, et al. Consensus Standards for Acquisition, Measurement,
  36. and Reporting of Intravascular Optical Coherence Tomography Studies. Journal of the American College of Cardiology. mars
  37. ;59(12):1058-72.
  38. Mehanna E, Bezerra HG, Prabhu D, Brandt E, Chamié D, Yamamoto H, et al. Volumetric Characterization of Human Coronary
  39. Calcification by Frequency-Domain Optical Coherence Tomography. Circ J. 2013;77(9):2334-40.
  40. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self-Care for the Prevention and Management of Cardiovascular
  41. Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. JAHA. 22 sept
  42. ;6(9):e006997.
  43. Kobayashi Y, Okura H, Kume T, Yamada R, Kobayashi Y, Fukuhara K, et al. Impact of target lesion coronary calcification on stent
  44. expansion. Circ J. 2014;78(9):2209-14.
  45. Brinton TJ, Ali ZA, Hill JM, Meredith IT, Maehara A, Illindala U, et al. Feasibility of Shockwave Coronary Intravascular Lithotripsy for
  46. the Treatment of Calcified Coronary Stenoses. Circulation. 5 févr 2019;139(6):834-6.
  47. Barbato E, Carrié D, Dardas P, Fajadet J, Gaul G, Haude M, et al. European expert consensus on rotational atherectomy.
  48. EuroIntervention. mai 2015;11(1):30-6.
  49. Sakakura K, Funayama H, Taniguchi Y, Tsurumaki Y, Yamamoto K, Matsumoto M, et al. The incidence of slow flow after rotational
  50. atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed. Cathet Cardio Intervent. avr
  51. ;89(5):832-40.
  52. Ali ZA, Karimi Galougahi K, Maehara A, Shlofmitz RA, Ben-Yehuda O, Mintz GS, et al. Intracoronary Optical Coherence Tomography
  53. : Current Status and Future Directions. JACC Cardiovasc Interv. 26 déc 2017;10(24):2473-87.
  54. Karimi Galougahi K, Shlofmitz E, Jeremias A, Gogia S, Kirtane AJ, Hill JM, et al. Therapeutic Approach to Calcified Coronary Lesions:
  55. Disruptive Technologies. Curr Cardiol Rep. 5 mars 2021;23(4):33.
  56. Généreux P, Madhavan MV, Mintz GS, Maehara A, Palmerini T, Lasalle L, et al. Ischemic outcomes after coronary intervention of
  57. calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization
  58. and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J
  59. Am Coll Cardiol. 13 mai 2014;63(18):1845-54.
  60. Gupta T, Weinreich M, Greenberg M, Colombo A, Latib A. Rotational Atherectomy: A Contemporary Appraisal. Interv Cardiol. nov
  61. ;14(3):182-9.
  62. Sakakura K, Inohara T, Kohsaka S, Amano T, Uemura S, Ishii H, et al. Incidence and Determinants of Complications in Rotational
  63. Atherectomy: Insights From the National Clinical Data (J-PCI Registry). Circ Cardiovasc Interv. nov 2016;9(11):e004278.
  64. Brener SJ, Cristea E, Kirtane AJ, McEntegart MB, Xu K, Mehran R, et al. Intra-Procedural Stent Thrombosis. JACC: Cardiovascular
  65. Interventions. janv 2013;6(1):36-43.
  66. Allali A, Abdel-Wahab M, Elbasha K, Mankerious N, Traboulsi H, Kastrati A, et al. Rotational atherectomy of calcified coronary
  67. lesions: current practice and insights from two randomized trials. Clin Res Cardiol. sept 2023;112(9):1143-63.
  68. Allali A, Richardt G, Toelg R, Elbasha K, Sulimov DS, Kastrati A, et al. High-speed rotational atherectomy versus modified balloons for
  69. plaque preparation of severely calcified coronary lesions: two-year outcomes of the randomised PREPARE-CALC trial. EuroIntervention.
  70. avr 2023;18(16):e1365-7.
  71. Jurado-Román A, Gonzálvez A, Galeote G, Jiménez-Valero S, Moreno R. RotaTripsy: Combination of Rotational Atherectomy and
  72. Intravascular Lithotripsy for the Treatment of Severely Calcified Lesions. JACC Cardiovasc Interv. 12 août 2019;12(15):e127-9.
  73. Gonzálvez-García A, Jiménez-Valero S, Galeote G, Moreno R, López de Sá E, Jurado-Román A. « RotaTripsy »: Combination of
  74. Rotational Atherectomy and Intravascular Lithotripsy in Heavily Calcified Coronary Lesions: A Case Series. Cardiovasc Revasc Med.
  75. févr 2022;35:179-84.