Shockwave Lithotripsy vs Rotational Atherectomy: Mechanistic Differences From Optical Coherence Tomography.

Management of calcified coronary lesions remains challenging, with frequent stent underexpansion and suboptimal results, which lead to early and late stent failure. Appropriate lesion preparation and optimal stent expansion are the keys to prevent stent failure. We present an unusual case of extensive sever right coronary artery calcified stenosis, in which both rotational atherectomy (RA) and non-compliant balloons failed to dilate the lesion and finally the Shockwave lithotripsy balloon offered optimal lesion dilation and successful stent deployment. Furthermore, optical coherence tomography provided mechanistic insight into the differential effect of Shockwave balloon versus RA for extensively calcified lesions.