Intravascular lithotripsy in heavily calcified unprotected left main with involvement of LAD ostium taking-off at extreme angulation - Taking upon an ‘Armageddon’

Calcific left main disease poses a tricky situation for various atherectomy devices including rota-ablation, orbital and directional atherectomy. However, with the advent of intravascular lithotripsy (IVL) in the armamentarium for complex percutaneous coronary intervention (PCI), left main calcium has been relatively easier to tackle. We encountered one of such situation wherein calcific left main disease along with ostial left anterior descending (LAD) artery involvement had to be dealt with in addition to the challenge faced in wiring LAD due to a peculiar anatomical hindrance. To the best of our knowledge, this wiring trick is not described in the literature yet.