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Coronary artery disease since 2018.While taking OMT, the clinic for angina pectoris was preserved. On 12.2020, PCI was performed: severe calcification of the coronary arteries, stenosis of the LAD by 80% in the middle segment, RCA by 60% in the middle segment. Rotational atherectomy and stenting of LAD DES 3.5 * 34 mm were performed. The measured FFR RCA is 0.78. Scheduled revascularization in the PKA basin was recommended. 

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Clinical blood test: RBC - 4.4 10 in 12 tbsp. / l; HGB - 132 g / l; NST - 41%; MCV - 91.3 cubic meters; PLT - 166 10 in 9 st. / l; MPV - 11 cubic meters; Leukocytes - 9 10 in 9 tbsp. / l; Segmented neutrophils,% - 68%; Lymphocytes,% - 21%; Monocytes,% - 9.5%; Eosinophils,% - 1%; Basophils,% - 0.5%; Erythrocyte sedimentation rate - 32 mm / h;Biochemical blood test: Potassium - 4.14 mmol / l; Glucose - 5.59 mmol / L; GFR (MDRD) M - 85.55 ml / min / 1.73m2; Serum creatinine - 82.9μmol / l.

Coronary blood supply type: right. Severe calcification of the coronary arteriesThe left main (LM) with uneven contoursThe left anterior descending (LAD)  with uneven contours, in the middle segment there is a stented area, without signs of restenosis, thrombosis.The circumflex artery (OA) and its branches with uneven contours throughoutThe right coronary artery (RCA): with uneven contours, in the middle segment it is stenosed by 60%.
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A guiding catheter is installed in the RCA orifice. The coronary guidewire was inserted into the distal RCA. Balloon catheters 2.0x20 mm, 2.5x15 mm NC, 3.0x15 mm NC 3.5-15 mm were used to pre-dilate the RCA. Incomplete deployment of balloon catheters was noted. Change of guidewire to RotaWire. Rotational atherectomy of the stenotic RCA was successfully performed with the RotaLink Burr 1.75 mm bur. A 3.5-15 mm balloon catheter was used to pre-dilate the middle segment of the RCA under a pressure of 28 atm. The control CAG revealed extravasation of contrast agent. A DES 3.5–39 mm stent was implanted into the middle segment of the RCA using a Guideliner catheter at a pressure of 16 atm. Control angiography shows preservation of contrast extravasation. PK Papyrus 3.5x15 mm stent graft was implanted in the middle segment of the RCA, under a pressure of 20 atm. Protamine sulfate 1% - 5 ml was injected intravenously. Control CAG showed no extravasation of contrast agent. A 3.5x20 mm balloon catheter was used to post-dilate the stented portion of the RCA under a pressure of 16-20 atm. Control OCT RCA was performed, data on significant abnormal position of the stents, dissection and perforation of the artery were not obtained. Control angiography showed that the stents were extended, without signs of thrombosis and arterial dissection.
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In severely calcified coronary arteries, perforation is one of the most common complications of PCI, so before starting the procedure, make sure you have the means to treat this complication.Knowledge of treatment methods and the availability of the necessary tools in the catheterization laboratory will help the operator to quickly eliminate complications arising from PCI.