Abstract
Heavily calcified coronary lesions remain a major challenge during percutaneous coronary intervention because severe calcification may impair balloon expansion and prevent successful stent delivery. We report a 70-year-old man with hypertension and previous coronary stenting who presented with exertional left-sided chest pain. Electrocardiography showed approximately 1-mm ST-segment depression in leads III and aVF. High-sensitivity cardiac troponin T was 0.045 ng/mL, above the laboratory upper reference limit of 0.01 ng/mL, without significant dynamic change. Coronary angiography demonstrated diffuse severe calcification with approximately 80% severe stenosis involving the proximal and mid left anterior descending artery. During the initial PCI attempt, the guidewire crossed the lesion; however, conventional balloon angioplasty failed to adequately expand the lesion. A 3.0-mm non-compliant balloon remained markedly waisted despite high-pressure inflation, and the drug-eluting stent could not cross the lesion. The procedure was stopped with preserved TIMI III flow. The patient was subsequently referred to a center with advanced plaque-modification capability. Rotational atherectomy was performed, followed by scoring-balloon angioplasty, allowing successful delivery and implantation of a drug-eluting stent. This case highlights the importance of early recognition of severe coronary calcification, avoiding forceful stent delivery across an inadequately prepared lesion, and selecting an appropriate plaque-modification strategy.
