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Abstract Background Drug-coated balloons (DCB) have been well-studied as a modality of percutaneous intervention (PCI) for the management of in-stent restenosis (ISR) in numerous trials. Proper lesion preparation has been the Achilles heel for DCB and is essentially the cornerstone for its proper use. Shockwave intravascular lithotripsy (IVL) is considered one of the safe and effective techniques for cracking heavy coronary artery calcifications (CAC) to allow proper stent expansion. There have been a few reports illustrating the safety and efficacy of the use of IVL technology to achieve satisfactory stent expansion in heavily calcific ISR. Case presentation In this report, we are presenting a resistant calcific ISR in a post coronary artery bypass surgery (CABG) patient which was successfully managed by IVL followed by DCB. Conclusions IVL followed by PCI using DCB has been shown to be safe and effective in cases of ISR with dense CAC. The technique needs to be further assessed by more studies to be adopted on a wider scale.
Zaalouk et al. (Thu,) studied this question.