Intravascular lithotripsy (IVL) is emerging as a novel, effective, easy-to-perform, and safe therapy for plaque modification in calcified lesions. So far, data on its use and outcomes mostly derives from stable patients with moderate angiographic complexity. Here we report on a case in which IVL was performed in the context of a high-risk intervention involving calcified lesions of the left main bifurcation and proximal left anterior descending, which required mechanical support with a percutaneous left ventricular assist device. This guaranteed hemodynamic stability and optimal lesion preparation, which allowed achieving a good angiographic result and clinical outcome.
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