(A, B) Basal angiogram with severe calcified stenosis in distal left main (LM) (Medina classification: 1-0-0) (arrows). (C) Intravascular lithotripsy was performed in LM to left anterior descending artery with a 3.5-mm balloon (arrows). Pulse delivery was carried out in a stationary manner (5 pulses each), with successful result. (D) A 3.5 × 18 mm drug-eluting stent was implanted in LM to left anterior descending (arrows). (E) Proximal optimization technique with 4.5 × 8 mm noncompliant balloon was performed (arrows). (F to H) Angiogram post-stenting with adequately luminal gain without associated complications (arrows).