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Reference 1. Jurado-Román A, Gonzálvez A, Galeote G, Jiménez-Valero S, Moreno R. RotaTripsy: Combination of rotational atherectomy and intravascular lithotripsy for the treatment of severely calcified lesions. JACC Cardiovasc Interv 2019; 12: e127 – e129. A 74-year-old woman underwent coronary angiography showing severely calcified lesions in the ostial and mid-left circumflex artery (LCx) with patent graft to the left anterior descending artery and occluded graft to the LCx (Figure A). Even after multiple rotational atherectomies (RA) with a 1.5-mm burr (Figure a), optical coherence tomography (OCT) demonstrated almost unmodified massive calcified nodules (CN) in the ostium, with multiple intimal microdissections (Figure b–d). Accordingly, intravascular lithotripsy (IVL; Shockwave Medical, Fremont, CA, USA), which was introduced more recently as an alternative to atherectomy for the treatment of calcified coronary lesions, was performed using a 3.5×12-mm IVL balloon, in which 40 pulses were applied (Figure a’). OCT clearly showed disrupted CN with enlarged lumen; specifically, deep fractures were created on CN (Figure b’–d’). Finally, an excellent angiographic result was obtained with Received August 20, 2019; accepted August 21, 2019; J-STAGE Advance Publication released online October 3, 2019 Time for primary review: 1 day Cardiovascular Science, Imperial College London, London (T.W.), UK; Division of Cardiology, St. Marianna University School of Medicine, Kawasaki (T.W., Y.J.A.), Japan; and Interventional Cardiology, Hospital Clínico San Carlos, Madrid (C.H.S., N.G., J.E.), Spain Mailing address: Takayuki Warisawa, MD, Imperial College London, Du Cane Road, London W12 0NN, UK. E-mail: warisawa-tky@ umin.ac.jp ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Successful Disruption of Massive Calcified Nodules Using Novel Shockwave Intravascular Lithotripsy