Case Report: Overcoming calcified nodules by repeated aggressive debulking and stent-free percunatenous coronary intervention using a drug-coated balloon.

Background: The outcomes of percutaneous coronary intervention (PCI) for calcified nodules (CNs) has been unsatisfactory results, even with the use of drug eluting stents. The optimal treatment strategy for CNs continues to be a matter of debate, with no definitive solution in sight. Case Presentation: We present a case of a 76-year-old male with recurrent restenosis due to a CNs in the ostium of left circumflex artery. He underwent repeated stent-free PCI with aggressive debulking using atherectomy devices followed by drug coated balloon (DCB). Outcome: The patient experienced recurrent restenosis every six months; however, after undergoing three sessions of stent-free PCI using atherectomy device and DCB, the lesion remained free of restenosis witch was confirmed at 4 years follow up. Conclusion: This case highlights the potential of repeated stent-free PCI with debulking of calcified tissue followed by DCB angioplasty as a viable treatment option for CNs.