It provides an overview of the problems of treatment of patients with diffuse multivessel coronary disease, carried out on the basis of an analysis of current research and clinical practice guidelines. It has been shown that percutaneous coronary intervention can act as the only alternative method of myocardial revascularization in patients with diffuse atherosclerosis of the coronary arteries who were refused coronary artery bypass grafting surgery due to a severe comorbid background or unfavorable morphology of the lesion, as well as in patients who themselves refuse to perform open surgery. It is noted that the integrated use of intravascular imaging techniques to avoid undue interference, complications during stenting procedures, as well as to determine the necessary amount of revascularization that, in general, contribute to the significant improvement in long-term outcomes of interventions and revising existing views on the endovascular treatment of patients with diffuse atherosclerosis. © Creative Cardiology 2021.