Shock Wave Intravascular Lithotripsy (IVL)-Assisted Staged Percutaneous Coronary Intervention (PCI) for a Calcified Right Coronary Artery in a Patient With Unstable Angina: Shock the Rock.

Coronary artery calcification represents one of the challenging and demanding subsets of percutaneous coronary intervention (PCI). Accumulated evidence has aptly outlined that shockwave intravascular lithotripsy (IVL) is a reliable tool to overcome calcified stenosis in coronary arteries. However, there is a lack of published case reports in the Indian context. Herein, we describe a case of right coronary artery (RCA) calcifications successfully managed with shock wave IVL-assisted staged PCI. Initially, a 74-year-old male patient presented with ST-segment elevation myocardial infarction (STEMI). At that time, coronary angiography demonstrated calcific thrombotic occlusion in the left anterior descending artery (LAD) and stenosis in proximal and mid tubular RCA. It was decided to proceed with immediate PCI of LAD followed by staged PCI of RCA. The patient presented with unstable angina at the time of the second repeat PCI of RCA and was managed with shock wave IVL-assisted staged PCI. Ultimately, the patient's condition was improved with good thrombolysis in myocardial infarction (TIMI) flow.