Abstract
Coronary artery calcification (CAC) is recognized as an independent predictor for major cardiovascular events. Rotational atherectomy (RA), orbital atherectomy system, and intravascular lithotripsy (IVL) are used to treat severe CAC. Among these, IVL is associated with a notably low risk of complications, such as slow flow and coronary artery perforation. A 70-year-old man with exertional angina underwent percutaneous coronary intervention for chronic total occlusion of the right coronary artery. RA was performed on a severely calcified lesion; however, the RA could not be advanced through the lesion, resulting in guidewire rupture and slow coronary flow. Due to the difficulty in proceeding with RA, IVL was attempted as a bailout strategy. Good stent expansion was achieved using IVL for residual calcified lesions, and the ruptured guidewire was secured beneath the stent. In cases where safe treatment cannot be accomplished with RA alone, the use of IVL following RA may be considered desirable. LEARNING OBJECTIVE: Intravascular lithotripsy (IVL) is associated with a low risk of complications, such as slow flow and coronary artery perforation.IVL serves as a useful bailout strategy when rotational atherectomy cannot be continued due to complications such as slow coronary flow and perforation.