Abstract
Coronary artery calcification (CAC) remains one of the greatest challenges in percutaneous coronary interventions, since it adversely affects procedural and long-term clinical outcomes. Compared with angiography, intravascular imaging increases diagnostic accuracy of CAC and enables assessment of morphological features of CAC, which help determine the need for advanced calcium modification therapies, including speciality balloons, atherectomy and intravascular lithotripsy. Since the ultimate goal of the advanced calcium modification therapies is to induce calcium fracture and facilitate subsequent stent implantation, intravascular imaging can be used to confirm calcium fracture and optimise percutaneous coronary interventions. Being able to interpret and understand the role of intravascular imaging in the diagnosis and management of CAC is valuable in attempting to improve outcomes after percutaneous coronary interventions.