73 years old gentleman heavy smoker presented with NSTEMI. His coronary angiography showed significant OM1 lesion and heavily fibrocalcific mid LAD.
Finally cracked by using :
 shock wave balloon (IVL), which inflated to 4 then 6 atm to deliver energy through 20 audible clicks(2 cycles).
After mid LAD stenting , a catastrophic distal edge perforation happened
Managed by prolonged balloon inflation for 3 times , every time is 5 minutes, proximal to the perforation site
The perforation completely sealed under fluoroscopy and serial Echo Doppler screening
Relook coronary angiography on the second day to fix a residual proximal lesion done without any staining or complications.