Intravascular Lithotripsy With or Without Rotational Atherectomy for Coronary Calcified Nodule Treatment

Inclusion Criteria * Age ≥18 years who signed written informed consent * Presence of a clinical indication for coronary intervention * Patients undergoing PCI for a de novo calcified lesion with planned drug-eluting stent (DES) implantation * Native coronary artery with significant stenosis defined as: * ≥70% and \<100% stenosis on angiography, or * 50-70% stenosis with evidence of ischemia (positive stress test, FFR ≤ 0.8, or OCT minimal lumen area (MLA) ≤ 4.0 mm2) * Reference vessel diameter: ≥2.5 mm to ≤ 4.0 mm * Lesion length: ≥5mm * Moderate to severe calcification of the target lesion confirmed by angiography * Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 at baseline Exclusion Criteria * Cardiogenic shock at the time of procedure * Primary PCI for ST-segment elevation myocardial infarction (STEMI) * Pregnant, nursing, or childbearing potential without adequate contraception * Known allergy or contraindication to DAPT (aspirin, clopidogrel, prasugrel, ticagrelor) * Planned surgery within 6 months unless DAPT can be maintained * Life expectancy \<12 months due to a serious medical illness (e.g., advanced cancer, end-stage heart failure) * Severe kidney dysfunction (CrCl \<30 mL/min) without dialysis * Concurrent participation in another investigational study * Referral for coronary artery bypass grafting (CABG) after a heart team discussion * Angiographic evidence of thrombus at the target lesion * Angiographic evidence of significant dissection at the treatment site prior to intervention * Lesion with a previously placed stent within 10mm (visual estimate) * Last remaining vessel with severely compromised left ventricular function (LVEF \<30%) * Target lesion within a saphenous vein graft (SVG)