Changing paradigm for treatment of heavily calcified coronary artery disease. A complementary role of rotational atherectomy and intravascular lithotripsy with shockwave balloon: a case report

BACKGROUND: Management of heavily calcified coronary arteries is still a major challenge in interventional cardiology. Inadequate stent expansion in calcific lesions is the single most important predictor of stent thrombosis and in-stent restenosis. Rotational atherectomy (RA) is an important tool to modify the calcium burden but is associated with limitations and requires specific skills. Intravascular lithotripsy (IVL) is a novel technique to treat calcified stenotic lesions and has been proposed as an alternative to RA with promising results. CASE SUMMARY: We report a case of a patient with severely calcified right coronary artery stenosis successfully treated with combination of RA and IVL. DISCUSSION: In this case, we demonstrate that the RA and IVL are complementary strategies, not sufficient on their own and not alternative to each other.