Intravascular Lithotripsy and/or Mechanical Debulking for Severely Calcified Coronary Artery Lesions

Inclusion Criteria: General Inclusion Criteria: 1. ≥18 years of age; 2. Native coronary artery disease suitable for PCI; 3. Patients with stable ischemic heart disease or unstable ischemic heart disease (Unstable Angina, Non-ST Elevation Myocardial Infarction, ST-Elevation Myocardial Infarction), patients with concomitant cardiogenic shock. 4. Patient or legally authorized representative, signs a written Informed Consent form to participate in the study, prior to any study-mandated procedures; Angiographic Inclusion Criteria: 1. The target vessel reference diameter must be ≥2.5 mm. 2. De novo coronary lesions or calcific in-stent restenosis or suboptimal stent expansion in a severely calcified coronary segment: Unprotected or Protected Left Main, LAD, LCfx, Ramus, RCA. 3. Angiographic stenosis \> 70% or stenosis \> 50% and \< 70% with FFR \< 0.80 or iFR \< 0.90 or IVUS or OCT minimum lumen area ≤4.0 mm²; 4. Evidence of calcification at the lesion site: angiographic calcifications (Mintz el al Classification) are described as : None/mild, Moderate (radio-opacities noted only during cardiac cycle prior to contrast injection) severe calcification: radio-opacities seen without cardiac motion prior to contrast injection, usually affecting both sides of the arterial lumen. Exclusion Criteria: 1. Patient is participating in another research study involving an investigational agent (pharmaceutical, biologic, or medical device) that has not reached the primary endpoint; 2. Patient is pregnant or nursing (a negative pregnancy test is required for women of child-bearing potential within 7 days prior to enrollment); 3. Patient has an allergy to imaging contrast media which cannot be adequately pre-medicated; 4. Patient has an active systemic infection on the day of the index procedure with either fever, leukocytosis or requiring intravenous antibiotics;