Vol. 3 No. 2 (2026): April - June
73-82
2026-06-29
Open Access

Innovative technologies in endovascular treatment of calcified and complex coronary lesions and LMCA revascularization strategies: a systematic literature review

Bakhtiyor A.Yuldashov
Khurshid G.Fozilov
Bakhtiyor R.Atamuratov
https://doi.org/10.70626/cardiouz-2026-3-00089

Received: 2026-02-22

Published: 2026-06-29

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Abstract

This systematic literature review evaluates innovative technologies for endovascular treatment of calcified and complex coronary lesions (intravascular lithotripsy, rotational and orbital atherectomy, drug-coated balloons) and left main coronary artery (LMCA) revascularization strategies (PCI versus CABG comparative analysis). Aim. To systematically assess the efficacy and safety of innovative technologies in treating calcified and complex coronary lesions, and to evaluate comparative outcomes of PCI versus CABG in LMCA disease. Methods. A systematic search of 80 scientific sources published between 2006 and 2025 was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases, including major RCTs (Disrupt CAD I–IV, ROTAXUS, PREPARE-CALC, ORBIT I–II, BASKET-SMALL 2, PICCOLETO II, AGENT IDE, SYNTAX, EXCEL, NOBLE, PRECOMBAT), meta-analyses, and international consensus documents. Results. Intravascular lithotripsy (IVL) demonstrated >90% technical success with low complication rates in calcified coronary stenoses. In LMCA disease, PCI and CABG showed similar outcomes in patients with SYNTAX score ≤22, while CABG demonstrated superiority at SYNTAX score ≥33. Per IPD meta-analysis, spontaneous MI risk was 2.35-fold higher in the PCI group (p<0.0001). DCB was confirmed non-inferior to DES in small vessel disease. Conclusion. Innovative calcification modification technologies have significantly expanded treatment options for complex coronary lesions. In LMCA disease, SYNTAX score, diabetes status, and Heart Team approach are critical determinants for revascularization strategy selection.

Keywords

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About the Authors

Bakhtiyor A.Yuldashov
ybaxtiyorjon@gmail.com
Republican Specialized Scientific and Practical Medical Center of Cardiology
Khurshid G.Fozilov
hurshidfozilov1976@icloud.com
Republican Specialized Scientific and Practical Medical Center of Cardiology
Bakhtiyor R.Atamuratov
baxtiyor-cardio@mail.ru
Republican Specialized Scientific and Practical Medical Center of Cardiology

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Innovative technologies in endovascular treatment of calcified and complex coronary lesions and LMCA revascularization strategies: a systematic literature review (B. Yuldashov, K. Fozilov, & B. Atamuratov, Trans.). (2026). CARDIOLOGY OF UZBEKISTAN, 3(2), 73-82. https://doi.org/10.70626/cardiouz-2026-3-00089
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