Euro4C Cases - the management of complex patients with calcified CAD

Euro4C stands for the Cardiac Care of Calcified and Complex patients in response to a growing problem within the aging population. Its mission is to work on improving the clinical outcomes of complex patients with advanced, diffuse and calcified atherosclerotic CAD, often presenting in critical conditions and left ventricular dysfunction.

In this section you will find a selection of cases on the subject of the management of complex patients with calcified CAD, submitted by members of the Euro4C Group. Find out more about the members of the Euro4C Editorial Team.

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37 results

Hostile left main calcific stenosis in HFrEF

20 Aug 2025

Analyse this case to find out how to successfully manage a patient with a severely calcific left main stenosis and severely reduced ejection fraction.

Emanuele Gallinoro

Author

Emanuele Gallinoro
Riccardo Terzi

Author

Riccardo Terzi

Author

Francesca Di Lenarda
Hostile left main calcific stenosis in HFrEF

How to manage a stalled burr: tips and tricks

30 Jul 2025

A stalled rota burr is every operator’s nightmare — but being prepared can make all the difference. In this case, an 80-year-old patient with severe calcification in the proximal and mid LAD faces exactly that complication.

What’s your first step to safely retrieve the burr and complete...

Petros Dardas

Author

Petros Dardas
Nikolaos Mezilis

Author

Nikolaos Mezilis
How to manage a stalled burr: Tips and tricks

When high calcium burden meets a 75 year-old patient with previous CABG + SAVR + MVr

02 Jul 2025

This case illustrates how a fragile patient with severe three-vessel disease involving LM/LAD was treated. Watch now to find out more, and share your thoughts!

Filippo Pensotti

Author

Filippo Pensotti
Luca Testa

Author

Luca Testa
When high calcium burden meets a 75 year-old patient with previous CABG + SAVR + MVr: an intricate PCI stands as the last line of defense

Calcium is not a rocket science

07 May 2025

We present the case of an 83-year-old man admitted with chronic coronary syndrome.

Coronary angiography revealed critical long calcified LAD stenosis. Complex PCI with different plaque modification techniques and intravascular imaging guiding was necessary to reach the success.

Piotr Kubler

Author

Piotr Kubler
Wojciech Zimoch

Author

Wojciech Zimoch
Wiktor Kuliczkowski

Author

Wiktor Kuliczkowski
Krzysztof Reczuch

Author

Krzysztof Reczuch
Calcium is not a rocket science

Complex PCI for severely calcified, uncrossable RCA lesion

07 Apr 2025

A 72-year-old male patient with stable coronary artery disease was admitted for recurrence of angina (CCS II/III). Coronary angiography revealed significant stenosis in the mid-portion of RCA. Ad hoc PCI of RCA was unsuccessful due to an uncrossable lesion...

Michal Hawranek

Author

Michal Hawranek
Lukasz Pyka

Author

Lukasz Pyka
Complex PCI for severely calcified, uncrossable RCA lesion

How to deal with a difficult angle

20 Mar 2025

In this case, the authors offer their perspective on treating a highly calcified circumflex coronary artery while dealing with a very unfavourable angle in a patient with extensive and known coronary disease.

María Beltrán

Author

María Beltrán
Frank Sliwinski Herrera

Author

Frank Sliwinski Herrera
Daniele Gemma

Author

Daniele Gemma
Jorge Palazuelos

Author

Jorge Palazuelos
How to deal with a difficult angle

Treating an “uncrossable” lesion

20 Feb 2025

A 76-year-old man with multiple cardiovascular risk factors presents with unstable angina, despite optimal medical therapy. Facing a complex, tight, and calcified lesion, the decision between PCI and CABG is critical. Join us as we discuss his diagnosis, risk assessment, and approach to treatment, and see...

Ruxandra Sava

Author

Ruxandra Sava
Pietro L. Laforgia

Author

Pietro L. Laforgia
Treating an “uncrossable” lesion

Less is sometimes more

09 Jan 2025

This case demonstrates the strategy and toolbox for treating a patient with chronic kidney disease and heavily calcified multivessel disease.

Judit Andréka

Author

Judit Andréka

Author

Sascha Paetzold
Dr. Gabor G. Toth

Author

Gabor G. Toth
Less is sometimes more

Hostile iliac access managed with IVL - How far can we go?

10 Oct 2024

Analyze this case to find out how to successfully manage a patient with severe aortic stenosis and severely calcified peripheral vasculature referred to transcatheter aortic valve implantation.

Simone Fezzi

Author

Simone Fezzi

Author

Flavio Luciano Ribichini
Hostile iliac access managed with IVL - How far can we go?

Fighting with calcium is always a struggle

12 Sep 2024

Managing calcified lesions is always a challenge, and while rotablation is the default technique, other methods must sometimes be considered, especially for eruptive calcified nodules, such as Shockwave, OPN balloon, or orbital atherectomy.

Petros Dardas

Author

Petros Dardas
Nikolaos Mezilis

Author

Nikolaos Mezilis
Fight with calcium is always a struggle