[Seniors and coronary calcified lesions]

Coronary artery calcification is highly prevalent in elderly patients and poses significant challenges during percutaneous coronary intervention (PCI). We report the case of an 86-year-old man admitted for ST-elevation myocardial infarction. Coronary angiography revealed triple-vessel disease with an acute coronary artery occlusion, a long, heavily calcified proximal-to-mid left anterior descending artery stenosis, and a severely calcified proximal circumflex lesion. PCI revascularization was performed in 3 steps: primary PCI of the right coronary artery initially, then 3 days after, PCI of the circumflex artery using rotational atherectomy, scoring balloon dilation, and intravascular lithotripsy. Then, at Day 15, PCI of the left anterior descending artery with orbital atherectomy finished complete revascularization. This case underscores the importance of a comprehensive geriatric assessment-particularly frailty and physiological age-before selecting a revascularization strategy requiring the use of specific tools as advanced plaque-modification techniques and intravascular imaging, without any restriction according to age.