Coronary artery disease (CAD) and peripheral arterial disease (PAD) are common, chronic conditions defined by a buildup of calcified plaque in the arteries. The treatment landscape for artery calcification includes preventative lifestyle changes, medications, and medical interventions like angioplasty and intravascular lithotripsy (IVL). This article gives an overview of common CAD/PAD treatments and management strategies. 

The Challenges of Treating Calcified Plaque in Arterial Diseases Like CAD and PAD

The central element of arterial diseases like CAD and PAD is the hard, calcific plaque that builds in the arteries and obstructs the flow of blood. These plaque deposits are a challenge to treat because of their hardness. As arteries become filled with plaque, it makes standard treatments less effective because the hardening vessel is less malleable and adaptable.(1,2,3)

The location of calcified plaque in the arteries is also challenging. Medial calcific plaque goes deeper and can be hard to reach with interventions. Intimal calcium deposits are situated closer to the artery's inner surface, and can act as an obstruction, blocking blood flow and complicating interventions.

As arterial plaque becomes calcified, it poses distinct challenges to drug delivery and may compromise stent expansion.(2,3) Calcified plaque may form intricate, napkin-ring lesions that are more difficult to treat with interventional therapies. This article goes into more detail about how cholesterol buildup can lead to calcified plaque in the arteries and cause PAD and CAD.

Many CAD and PAD patients are older and have other cardiovascular risk factors like hypertension (high blood pressure), which can complicate treatments. Comorbidities are common, making a one-size-fits-all treatment approach unrealistic for arterial calcification and CAD/PAD. Managing these conditions and treating arterial calcification involves a mix of prevention, medication, and sometimes medical interventions. 

Preventing CAD and PAD: A Healthy, Active Lifestyle Helps to Limit Artery Calcification 

CAD and PAD are chronic conditions that develop gradually over a person’s lifetime. Sometimes it can take decades of plaque buildup in the arteries before a person starts feeling symptoms from CAD or PAD.(4) Making healthy choices today can help limit plaque accumulation and lower the risk of arterial disease developing later on. The best way to prevent artery calcification before it leads to CAD and PAD is to live an active lifestyle with a healthy diet.

These Lifestyle Choices Can Help Prevent CAD and PAD

• Healthy diet: To promote arterial and heart health, it’s recommended to eat a diet that’s rich in whole foods and low on saturated fats, trans fats, cholesterol, and sodium.

• Exercise: Living a sedentary lifestyle is a major risk factor for artery calcification. Regular physical exercise improves cardiovascular health and can help manage risk factors like obesity, high blood pressure, and diabetes. Supervised exercise programs have been shown to improve symptoms of claudication (leg pain) associated with PAD.

• Avoid smoking: Smoking and tobacco are major risk factors for CAD and PAD. Quitting smoking is vital to preventing disease progression.

• Avoid excessive drinking: Limiting alcohol consumption can help limit risk factors for CAD and PAD.

• Talk to your doctor: It’s crucial for people at risk for artery calcification to schedule regular health check-ups and communicate with a trusted medical provider.(4)

People experiencing diabetes, obesity, and high blood pressure are at an increased risk of developing CAD and PAD.(4) For people with these conditions, monitoring symptoms and scheduling regular medical checkups is especially important.

Using Medications to Treat CAD/PAD and Minimize Risk Factors for Artery Calcification

Management of CAD and PAD with medications focuses on alleviating symptoms, stabilizing plaques, and addressing underlying risk factors that contribute to the progression of artery calcification. Several classes of medications are used to treat CAD, PAD, and their risk factors. These include:

• Antiplatelets (aspirin, clopidogrel): Prevent blood clots.

• Statins: Lower LDL "bad" cholesterol levels.

• Beta-blockers: Lower blood pressure and reduce the heart's workload.

• ACE inhibitors/ARBs: Lower blood pressure and provide other heart benefits.

• Calcium channel blockers: Lower blood pressure and control angina.

• Nitrates (nitroglycerin): Relieve chest pain or angina.

• Anticoagulants (warfarin, apixaban, rivaroxaban): Prevent blood clotting.

• Antihypertensives (ACE inhibitors, beta-blockers, calcium channel blockers): Reduce high blood pressure.

Be sure to talk to a trusted healthcare professional about any medications you’re considering to see if they’re right for you and your health situation.

Medical Interventions for Artery Calcification Include Angioplasty, Stents, and IVL

Treating calcified plaque in the arteries may require a common, traditional medical intervention such as angioplasty or stent deployment. In recent years, newer technologies and plaque modification techniques have emerged as cutting-edge options to treat more difficult calcium deposits.

Traditional treatments for artery calcification:

• Angioplasty: Also known as balloon angioplasty, this procedure attempts to clear blocked arteries of plaque using a balloon-tipped catheter.

• Stents: To keep open a congested artery, a metal scaffolding called a stent can be placed inside a vessel to aid in healing or relieve an obstruction.(5)

Innovative Medical Procedures Have Arisen to Treat More Challenging Cases of Calcified Plaque

In some cases, calcified plaque in the arteries is more difficult to modify due to the development of intricate, napkin ring-like lesions. Hard plaque in this shape may be too difficult to clear for traditional treatments.(5) To address plaque removal challenges, innovative new medical technologies have arisen.

Newer medical technologies used to treat calcified arteries:

• Drug-coated balloons (DCB): Medication-coated angioplasty balloons that release their drug upon inflation, reducing scar tissue formation.(6)

• Bare metal and drug-eluting stents: Bare metal stents provide immediate support to prevent artery collapse post-angioplasty. Drug-eluting stents are coated with medication, and help ensure the artery remains clear.(7)

• Plaque modification tools: Directional atherectomy devices aim to cut calcium deposits in the arteries. There are also specialty balloons equipped with unique elements that make precise incisions in calcified plaque, aiding in vessel expansion.

• Rotational atherectomy: A category of devices designed to “ablate” or remove heavily calcified plaque. These devices move rotationally, helping to address difficult plaque that stents or traditional balloon angioplasty may struggle with. 

Intravascular Lithotripsy (IVL) Uses Sound Waves to Help Fracture Calcified Plaque

Given the limitations of traditional plaque modification methods, the emergence of intravascular lithotripsy in recent years has been groundbreaking. IVL harnesses shock waves to target and fragment calcium deposits, both superficial and deep, while ensuring the vessel's integrity remains intact. By affecting some of the toughest arterial plaque deposits, IVL has the potential to transform the CAD and PAD treatment landscape.

Learn more about how intravascular lithotripsy works in this article.

You can also compare IVL to other artery calcification treatments in this article.