Coronary lithotripsy for failed rotational atherectomy, cutting balloon, scoring balloon, and ultra-high-pressure non-compliant balloon

Calcified and undilatable stenosis still represents a challenge in percutaneous coronary interventions (PCI), due to the higher risk of suboptimal result with consequent worse clinical outcomes. Unfortunately, the dedicated technologies and devices, such as specialized balloon and atherectomy systems, do not always provide adequate plaque modification and optimal vessel preparation allowing optimal stent delivery. The intravascular lithotripsy (IVL) is a technology derived from urology that has been tested in peripheral and coronary calcified plaques, with promising preliminary results. We present a case of a patient undergoing planned PCI of the right coronary artery targeting an undilatable lesion, already resistant to both specialized balloons and rotational atherectomy. Using the IVL system, we were able to break the calcium, guarantying optimal stent expansion with good final result.