I recently saw an Indonesian patient for a routine check-up. He is generally healthy, with well-controlled hypertension, diabetes, and hyperlipidemia. However, his screening revealed an extremely high calcium score of 5000+—a stark contrast to the ‘low-risk’ threshold of 100.
Despite being completely asymptomatic, his high-risk profile warranted an angiogram. Shockingly, it revealed triple-vessel disease with stenoses ranging from 70% to 99%. After discussing the option of bypass surgery, the patient opted for complex coronary angioplasty.
Treating vessels with such high calcium scores is notoriously challenging and often requires specialized plaque-modification devices. In this case, we initially trialed a balloon, and intravascular imaging surprisingly confirmed the calcium had cracked easily. I then used specialized scoring balloons to fully open the vessels. We successfully implanted two stents and used two drug-coated balloons to treat all three blockages. The 1.5-hour procedure went well, and the patient was discharged the following day. This case highlights why cardiac screening is essential; patients can remain entirely asymptomatic even with critical, life-threatening blockages.”
