Rotorbitripsy: "Ménage à Trois" for the Management of Coronary Calcification

The management of severely calcified coronary lesions still represents a major challenge, often associated with suboptimal angiographic results and poor long-term clinical outcomes. In recent years, novel calcium modification techniques have emerged as promising tools in routine practice, with evidence supporting their use primarily derived from observational studies. This case report aims to illustrate, for the first time, the synergistic and harmonized use of 3 calcium modification techniques (rotational atherectomy, orbital atherectomy and intravascular lithotripsy) in a single case. Additionally, we effectively demonstrate the direct impact of these different techniques on the calcified plaque using optical coherence tomography.