Balloon Lithoplasty for Preparation of Severely Calcified Coronary Lesions

Inclusion Criteria: * Age ≥ 18 years and \< 90 years * Stable coronary heart disease or non-ST elevation acute coronary syndrome * PCI planned in severely calcified, non-occluded, de-novo lesion in native vessel. Definition of severe calcifications (minimum 1 of 3 (i-iii)); i. Angiography: Radioopacities of the vessel wall visible on cine images before contrast injection on both sides of the vessel lumen in more than one projection. ii. OCT (before lesion preparation): Maximum calcium 1) angle \>180 degrees AND 2) thickness 0.5mm, AND 3) longitudinal length \>5m m. iii. IVUS (before lesion preparation): Maximum calcium angle \>270 degrees. * Functional evidence of ischemia (non-invasive stress test or fractional flow reserve) in the target vessel territory or stenosis ≥ 90% by visual estimate * Target vessel reference diameter visually estimated at 2.5-4 mm with ability to pass a 0.014" guidewire across lesion * Ability to tolerate dual antiplatelet therapy * Informed consent Angiographic exclusion criteria: * Unprotected left main stenosis * Chronic total occlusion * Severely calcified bifurcated lesion with expected need to use two stent technique * Coronary artery dissection Clinical exclusion criteria * ST-segment elevation acute myocardial infarction * Planned later revascularization in non-study lesions * Planned cardiovascular intervention within 30 days after study intervention * Clinical instability including decompensated heart disease * Life expectancy of less…