Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would like to know if you have any symptoms of coronary artery disease like episodes of chest pain during physical exertion or at rest or shortness of breath?

Did your performed tests conclude about any injury to the cardiac muscle (presence of myocardial infarction)?

I would like to directly review your performed cardiac tests reports (ECG, cardiac stress tests, cardiac enzymes, coronary angiogram), in order to give a more professional opinion on your clinical situation.

Anyway, I would like to explain that the presence of a coronary calcified occlusion means that it is very likely to be a chronic coronary lesion.

In that way a failure to open a calcified coronary occlusion should not be considered a disaster, as in such case the cardiac muscle obtaining quite deficient blood supply through this almost occluded coronary artery, gains some compensatory ways to provide the necessary blood flow and to balance its metabolic requirements with the deficient offers.

These compensatory mechanisms include:

1- new generation of collateral blood vessels (from the surrounding coronary arteries, to the hungry (suffering) myocardial muscle area
2- decreasing of the local cardiac muscle metabolism in order to balance the insufficient blood flow supply.

So, you shouldn't worry about this chronic calcified coronary artery as God (or the nature) has already done its own solution, before doctors could achieve any alternative therapeutic results.

Instead, what I would highly recommend you consider are the two other 50% stenotic coronary arteries, which should be closely monitored in order to intervene promptly in the right time to prevent any reversible damage on myocardial areas supplied by them.

Coming to this point, I would recommend you to be very attentive in case of any chest pain symptomatology and immediately ask medical assistance to detect any ongoing important cardiac ischemia.

What I would recommend in these boundary coronary stenosis (less than 75%, which is classically considered a clinically important coronary lesion), is performing what is called fractional flow reserve measurement (FFR).

Investigating the FFR values, would properly guide the doctors in the right decision whether these lesions need to be treated by stent implantation or to follow the alternative strategy of waiting and monitoring for a second treatment opportunity.

You should discuss with your doctor on the above mentioned issues.

Hope to have clarified your uncertainties!

Feel free to ask me again if you have any other questions!

Kind regards,

Dr. Iliri

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