الفهرس 
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Abstract
• We conducted a retrospective analysis of 101 patients presented by balloon crossable undilatable heavily calcified coronary lesions in Leiden university medical hospital, 51 were treated by RA and 50 were treated by IVL.
• We evaluated procedural success and 6-months clinical outcomes (all-cause mortality, TLR, stroke and stent thrombosis).
• We concluded that both IVL and RA are effective and safe techniques for preparation of balloon-crossable heavily calcified coronary lesions, showing high rates of procedural success, low in-hospital complication rates and no significant differences regarding MACE at 6-months follow-up.
Study limitations
Several limitations should be considered:
• This is a single-center, observational retrospective analysis of prospectively clinically acquired data, with all the inherent limitations associated to the nature of the study.
• Small sample size and limited follow up.
• The use of intracoronary imaging was low, especially in the RA group. These might be explained by absence of a protocol for using intracoronary imaging in PCI optimization in calcified lesions and may be lower awareness of the role of intravascular imaging in the historical RA cohort (whereas the use of intracoronary imaging for lesion characterization and PCI optimization has become standard in recent days) (Dong et al., 2020; Fujino et al., 2018; Shavadia et al., 2018).
Recommendations
• Further larger prospective studies with longer follow up are recommended to confirm our results.
• More usage of intracoronary imaging is recommended especially in presence of severe coronary calcification.