Improving the immediate and long-term results of endovascular treatment of a patient at extremely high surgical risk with coronary artery disease, diabetes mellitus and calcified multivessel coronary disease

The strategy of revascularization in severe calcified lesions is one of the most urgent problems of percutaneous coronary interventions (PCI). In recent decades, interest in rotational atherectomy has increased significantly, which is currently the method of choice for severe coronary calcification. A clinical example of successful endovascular treatment of a patient with a multivessel lesion with preliminary destruction of calcified atherosclerotic plaques by rotational atherectomy is presented. Patient K., aged 73, was hospitalized with a diagnosis of CHD: stable angina III functional class. Postinfarction cardiosclerosis (Q-forming myocardial infarction of the lower lateral localization from March 2022). Arterial hypertension. Type II diabetes mellitus. Type IIa dyslipidemia. The coronary angiography revealed 80% calcified stenosis in the terminal section of the main trunk of the left coronary artery with a transition to the proximal segment and 90% calcified stenosis in the middle segment of the anterior interventricular branch. The patient underwent endovascular rotational atherectomy followed by stenting of the affected segments of the coronary arteries. The postoperative period was uneventful, there was a positive trend in the condition: chest pain was not disturbed, including against the background of the expansion of the mode of physical activity, the symptoms of heart failure did not increase, and the patient was discharged on the 3rd day after the operation. At a planned control examination 3 months after the intervention, he noted an improvement in general well-being with an increase in the volume of physical activity without an angina clinic.