[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"menu":3,"$fsTTOmiJiEKttgkhC47Md-mq2ytqi7iZYYBg2C1yUQy8":210},{"main":4,"mainTranslated":17,"footer":45,"footerTranslated":109},[5,8,11,14],{"title":6,"url":7},"Course library","https:\u002F\u002Fwww.medmastery.com\u002Fcourse-library",{"title":9,"url":10},"Pricing","https:\u002F\u002Fwww.medmastery.com\u002Fpricing",{"title":12,"url":13},"Earn credits","https:\u002F\u002Fwww.medmastery.com\u002Fcme-credits",{"title":15,"url":16},"Institutions","https:\u002F\u002Fwww.medmastery.com\u002Finstitutions",{"de":18,"es":27,"fr":36},[19,21,23,25],{"title":20,"url":7},"Kurse",{"title":22,"url":10},"Preise",{"title":24,"url":13},"CME-Punkte",{"title":26,"url":16},"Organisationen",[28,30,32,34],{"title":29,"url":7},"Biblioteca de cursos",{"title":31,"url":10},"Precios",{"title":33,"url":13},"Gana créditos",{"title":35,"url":16},"Instituciones",[37,39,41,43],{"title":38,"url":7},"Cours",{"title":40,"url":10},"Tarifs",{"title":42,"url":13},"Obtenir des crédits",{"title":44,"url":16},"Établissements",[46,59,79,97],{"title":47,"group":48,"menu":49},"Company",true,[50,53,56],{"title":51,"url":52},"Our teachers","https:\u002F\u002Fwww.medmastery.com\u002Fteachers",{"title":54,"url":55},"About us","https:\u002F\u002Fwww.medmastery.com\u002Fabout-us",{"title":57,"url":58},"Work with us","https:\u002F\u002Fwww.medmastery.com\u002Fwork-with-us",{"title":60,"group":48,"menu":61},"Product",[62,64,67,70,73,76,78],{"title":63,"url":7},"Courses",{"title":65,"url":66},"Magazine","https:\u002F\u002Fwww.medmastery.com\u002Fmagazine",{"title":68,"url":69},"Podcast","https:\u002F\u002Fwww.medmastery.com\u002Fpodcasts",{"title":71,"url":72},"Webinars","https:\u002F\u002Fwww.medmastery.com\u002Fwebinars",{"title":74,"url":75},"Guides","https:\u002F\u002Fwww.medmastery.com\u002Fguides",{"title":15,"url":77},"https:\u002F\u002Fwww.medmastery.com\u002Finstitutions\u002F",{"title":9,"url":10},{"title":80,"group":48,"menu":81},"Legal",[82,85,88,91,94],{"title":83,"url":84},"Imprint","https:\u002F\u002Fwww.medmastery.com\u002Fimprint",{"title":86,"url":87},"Newsletter policy","https:\u002F\u002Fwww.medmastery.com\u002Fnewsletter-privacy-policy",{"title":89,"url":90},"Privacy policy","https:\u002F\u002Fwww.medmastery.com\u002Fprivacy-policy",{"title":92,"url":93},"Cookie Policy","https:\u002F\u002Fwww.medmastery.com\u002Fcookie-policy",{"title":95,"url":96},"Terms","https:\u002F\u002Fwww.medmastery.com\u002Fterms",{"title":98,"group":48,"menu":99},"Customer support",[100,103,106],{"title":101,"url":102},"FAQs","https:\u002F\u002Fwww.medmastery.com\u002Ffaqs",{"title":104,"url":105},"Contact","https:\u002F\u002Fwww.medmastery.com\u002Fcontact",{"title":107,"url":108},"support@medmastery.com","mailto:support@medmastery.com",{"de":110,"es":143,"fr":177},[111,118,128,137],{"title":112,"group":48,"menu":113},"Unternehmen",[114,116,117],{"title":115,"url":52},"Unsere Dozentinnen und Dozenten",{"title":54,"url":55},{"title":57,"url":58},{"title":119,"group":48,"menu":120},"Produkt",[121,122,123,124,125,126,127],{"title":20,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":26,"url":77},{"title":22,"url":10},{"title":129,"group":48,"menu":130},"Rechtliches",[131,133,134,135,136],{"title":132,"url":84},"Impressum",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":138,"group":48,"menu":139},"Kundenservice",[140,141,142],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[144,151,162,171],{"title":145,"group":48,"menu":146},"Empresa",[147,149,150],{"title":148,"url":52},"Nuestros profesores",{"title":54,"url":55},{"title":57,"url":58},{"title":152,"group":48,"menu":153},"Producto",[154,156,157,158,159,160,161],{"title":155,"url":7},"Cursos",{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":35,"url":77},{"title":31,"url":10},{"title":163,"group":48,"menu":164},"Información legal",[165,167,168,169,170],{"title":166,"url":84},"Aviso legal",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":172,"group":48,"menu":173},"Atención al cliente",[174,175,176],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[178,185,196,204],{"title":179,"group":48,"menu":180},"Entreprise",[181,183,184],{"title":182,"url":52},"Nos enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":276,"meta":354,"internal":364},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":244,"author":266,"readDuration":274,"readDurationFormatted":275},"PCI—managing calcified vessels","How do we deal with this enemy of PCI? Cutting balloons and rotablation! Using case demonstration, this video will give you an introduction into these techniques.",{"id":215,"name":216},1,"Course previews",[218,229,234,239],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},276,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Managing calcified vessels","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=MM_g0c7ydgE",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},10.666666666666666,"\u003Cp> \u003Cstyle type=\"text\u002Fcss\">\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--> \u003C\u002Fstyle> Calcification is the enemy of PCI—attempting to use a stent before preparing a calcified artery will likely lead to a myocardial infarction! In this case demonstration video, from our Percutaneous Coronary Interventions Essentials course, you'll learn about the methods used to deal with calcification, as well as the limitations of each.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},18.4,"Join our Percutaneous Coronary Intervention Essentials course today!","\u003Cp>Perform your own PCIs with our \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fpercutaneous-coronary-intervention-essentials\">Percutaneous Coronary Intervention Essentials\u003C\u002Fa> course. You’ll cover essential PCI equipment, lesion assessment, troubleshooting, and patient monitoring so that you can perform your own procedures under the supervision of an experienced cardiologist. This course will debunk common myths surrounding PCI patient selection so that you can offer it to more patients who need it. Get your \u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister\">FREE trial account\u003C\u002Fa> and start Chapter 1 now!\u003C\u002Fp>",{"type":230,"data":240},{"readDurationInSeconds":241,"title":242,"text":243},115.46666666666667,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:00:00]\u003C\u002Fb> Calcification is the enemy of PCI. If you're unable to dilate up a stenosis with a balloon, then it's impossible to treat the patient with stents. Some calcification within the wall of the artery goes completely around the artery known as circumferential calcification. Given its appearance, this is sometimes referred to as napkin ring\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:00:30] \u003C\u002Fb>calcification. Basically, you cannot deploy a stent unless you can crack this ring of calcification. If you try to deploy a stent without first preparing the vessel, the stent will not be able to fully expand or oppose the wall. This can lead to problems with flow in the vessel with a result in in-stent thrombosis and subsequent myocardial infarction.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:01:00] \u003C\u002Fb>Calcification is particularly seen in the elderly and as the population ages, it's, therefore, more commonly encountered during PCI procedures. One technique is to use a scoring or cutting balloon to modify the ring of calcification. These balloons work by having metal on the outside of the balloon and delivering focused pressure which leads to linear tears or cracks in the calcification\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:01:30] \u003C\u002Fb>so that the artery can then be further expanded with a normal balloon. They can however, be hard to deliver in tight spaces due to the bulkiness of the balloon from the metal component. There are a number of scoring or cutting balloons that are commercially available. So what if we can't insert a balloon because the lesion is too tight or it still won't expand? We either have to abandon the PCI or look to other methods.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:02:00] \u003C\u002Fb>In this video, you can see a rotor bar used in PCI. Rotational atherectomy or rotablation is a rotating bar that is tipped with industrial diamond and rotates very quickly around 160,000 reps per minute. This fragments the calcium into microscopic particles that are absorbed into the distal coronary circulation. Once we have modified\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:02:30]\u003C\u002Fb> the calcification, a normal balloon can then be used to dilate the lesion. A limitation of rotational atherectomy is that it's a complex procedure that requires considerable operator experience and training. It also necessitates the use of larger sized guiding catheters and has increased complications of dissection or no flow or slow flow within the artery. Special lubricated stainless steel rotor wires\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:03:00] \u003C\u002Fb>are also needed for rotational atherectomy. It is due to the heat generated by the rotating bar. These can be difficult to use and are not as easy to insert into a coronary artery when compared with normal angioplasty wires. If you can't insert a rotor wire through a lesion, you can't rotablate. Occasionally, people use laser catheters to create enough space to allow the passage of a rotor wire to continue then with rotational atherectomy.\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:03:30] \u003C\u002Fb>This works because laser catheters can travel over any normal workhorse wire. Whilst they can't deal with calcification on their own, lasers and then a combination of a laser followed by rotational atherectomy, also called razor, can be effective in complex calcified lesions where we cannot pass a rotor wire initially. Newer technologies include the use of sound or shockwaves to disrupt calcium in much the same way that lasertripsy is used for\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-949a8953-7fff-5223-feec-880a4240fd5c\">[00:04:00] \u003C\u002Fb>renal stones. Sound waves are delivered via balloon inserted over a standard wire. Limitations of this technology include the bulkiness of the balloon which may not be able to pass in severe or tight lesions. \u003C\u002Fp>",{"courses":245,"showAwardsBelow":48},[246],{"id":247,"isFreeCmeCourse":248,"title":249,"type":250,"specialization":251,"teachers":253,"cmeCredits":255,"teacherIllustration":256,"backgroundImage":257,"relativeUrl":258,"lastChanged":259,"created":260,"description":261,"relativeURL":258,"meta":262},6225,false,"Percutaneous Coronary Intervention Essentials","course",[252],"Cardiology",[254],"David G O’Brien, MD FRCP",6,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee2-c18c-46fb-97fa-c3870c926ac5","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ee3-6401-420b-86b0-ea0adf25dab5","\u002Fcourses\u002Fpercutaneous-coronary-intervention-essentials","1763556345","1558283528","Perform your own percutaneous coronary interventions (PCI) with this step-by-step course. You’ll cover essential PCI equipment, lesion assessment, troubleshooting, and patient monitoring so you can perform your own procedures under the supervision of an experienced cardiologist. This course will debunk common myths surrounding PCI patient selection so you can offer it to more patients who need it.",{"duration":263,"quizzes":264,"lessons":265},15477,8,55,{"id":267,"name":254,"image":268,"profession":269,"relativeUrl":272,"specializations":273},2550,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefe-fe4e-432c-9c46-803dfb2b5a31",{"name":270,"description":271},"Cardiologist","David is a Consultant Interventional Cardiologist and Clinical Director of Cardiology at the Lincolnshire Heart Centre in the UK, and is a passionate teacher.","\u002Fteachers\u002Fdavid-g-obrien-md-frcp",[252],152,"3m",[277,303,329],{"id":278,"title":279,"text":280,"image":281,"author":289,"path":298,"readDuration":299,"readDurationFormatted":275,"internal":300},1355,"Discover how pediatric ECG goes beyond the 12-lead ECG","Learn where three additional leads are placed for a pediatric ECG and how they help assess cardiac position, electrical activity, and congenital cardiac variants.",{"alt":282,"title":283,"size":284,"location":286},"Infant undergoing ECG lead placement while a clinician prepares for pediatric ECG","",{"width":285,"height":285},600,{"bucket":287,"key":288},"public-drupal-medmastery-assets-production","\u002F2026-06\u002FC144(1)_magazine image.png",{"id":290,"title":291,"relativeURL":292,"image":293,"professionLong":294,"profession":295,"weight":297},14047,"Peter F. Aziz, MD FHRS","\u002Fteachers\u002Fpeter-f-aziz-md-fhrs","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9ef4d18d-7b35-4843-a39a-5e3495d544df","\u003Cspan id=\"docs-internal-guid-bb2fbf38-7fff-c33a-a26a-a82f9d2d9c4a\">Pediatric Electrophysiologist, Professor of Pediatrics, and founder and director of the Inherited Arrhythmia Clinic.\u003C\u002Fspan>",{"name":296},"Pediatric Electrophysiologist",0,"\u002Fmagazine\u002F15-lead-pediatric-ecg",160,{"created":301,"updated":302,"published":302},1781900013,1781901055,{"id":304,"title":305,"text":306,"image":307,"author":314,"path":323,"readDuration":324,"readDurationFormatted":275,"internal":325},1354,"Evaluating bleeding & abdominal pain in early pregnancy","Learn how to evaluate a patient presenting with vaginal bleeding and abdominal pain in early pregnancy when ectopic pregnancy is a concern.",{"alt":308,"title":283,"size":309,"location":312},"Medical illustration of an ectopic pregnancy implanted in the fallopian tube outside the uterus",{"width":310,"height":311},1201,1200,{"bucket":287,"key":313},"\u002F2026-06\u002FC144(2)_magazine image.png",{"id":315,"title":316,"relativeURL":317,"image":318,"professionLong":319,"profession":320,"weight":322},12787,"Tori O’Daniel, MD FACOG","\u002Fteachers\u002Ftori-odaniel-md-facog","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf00-58e5-4b12-9d94-ce4fcf5697fc","Tori is a lead obstetrician (OB) hospitalist and Medical Director of OB Hospitalists and Women’s Services at Mercy Hospital, Oklahoma City.",{"name":321},"Lead obstetrician hospitalist",5312,"\u002Fmagazine\u002Fabdominal-pain-in-early-pregnancy",172,{"created":326,"updated":327,"published":328},1780855964,1780858467,1780858468,{"id":330,"title":331,"text":332,"image":333,"author":339,"path":348,"readDuration":228,"readDurationFormatted":349,"internal":350},1353,"Gestational age ultrasound in early pregnancy evaluation","Learn how to obtain the correct ultrasound views and accurately measure crown-rump length and biparietal diameter to estimate gestational age.",{"alt":334,"title":283,"size":335,"location":337},"Gestational age ultrasound image demonstrating crown-rump length measurement in the first trimester",{"width":336,"height":336},900,{"bucket":287,"key":338},"\u002F2026-05\u002FC144(1)_magazine image.png",{"id":340,"title":341,"relativeURL":342,"image":343,"professionLong":344,"profession":345,"weight":347},2976,"Viveta Lobo, MD","\u002Fteachers\u002Fviveta-lobo-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cefc-7f09-4a9a-9865-4aeea3cef318","\u003Cspan id=\"docs-internal-guid-57fc7959-7fff-8d74-e680-4d8102bdd254\">Associate Professor, Department of Emergency Medicine at Stanford University Medical Center in California, USA.\u003C\u002Fspan>",{"name":346},"Emergency medicine physician",507,"\u002Fmagazine\u002Fgestational-age-ultrasound","2m",{"created":351,"updated":352,"published":353},1780168728,1780322380,1780169720,{"seo":355,"og":357},{"title":356,"description":213},"PCI—managing calcified vessels | Medmastery",{"title":356,"description":213,"image":358},{"alt":283,"title":283,"size":359,"location":362},{"width":360,"height":361},303,182,{"bucket":287,"key":363},"\u002Fmigrated-images\u002Fpci-arterial-access-complications.png",{"id":365,"created":366,"updated":367,"published":366},306,1568025633,1655189586]