LAUSR

Successful percutaneous coronary intervention (PCI) of calcified coronary artery lesions is largely dependent on adequate lesion preparation. Failure to adequately address coronary calcification can lead to procedural failure, stent underexpansion, lower postproce-dural minimal luminal diameter, in ‐ stent restenosis, and increased risk of major complications. 1 In cases of severe coronary artery calcification, contemporary options for atherectomy include cutting and scoring balloons, rotational atherectomy (RA), orbital atherectomy, laser atherectomy, and intravascular lithotripsy. 2 In the most recent 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization, plaque modification with RA in patients with fibrotic or heavily calcified lesions is a Class 2a recommenda-tion, while orbital atherectomy, balloon atherotomy, laser angioplasty, and intracoronary lithotripsy are a Class 2b recom-mendation. 2 However, there is no consensus from guidelines or clinical trials regarding the optimal approach for combining lesion preparation strategies. The study presented in this issue of Catheterization and Cardiovascular Patel and colleagues, is a meta ‐ analysis of four studies that compared of patients undergoing RA followed by cutting balloon (RACB) or RA followed by plain balloon before ‐ stent and an open ‐ randomized