Assessing Calcified Coronary Lesions to Guide Percutaneous Coronary Intervention: From Angiography to Intracoronary Imaging

Background/Objectives: Coronary artery calcification is a leading cause of stent failure and a strong predictor of adverse outcomes after percutaneous coronary intervention (PCI). Accurate characterization of calcium burden, depth, and morphology is central to procedural planning, targeted treatment, and better outcomes. This review summarizes the contemporary armamentarium for imaging calcified coronary lesions, from coronary angiography and computed tomography to advanced intracoronary imaging, and how it facilitates treatment.