Abstract
The management of heavily calcified lesions, particularly in elderly patients with multiple comorbidities, presents significant challenges. These challenges are further complicated by the presence of a pacemaker and intra-aortic balloon pump insertion. The use of specialized techniques, such as rotational atherectomy (RA), to modify heavily calcified lesions has proven to be an effective approach in facilitating stent delivery and optimizing procedural outcomes. This report highlights the expertise and precise planning required in treating a high-risk patient with RA to assist in the placement of multiple overlapping Supraflex Cruz sirolimus-eluting stents (Sahajanand Medical Technologies Limited, Surat, India) in heavily calcified lesions.