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However, subsequent use of coronary intravascular lithotripsy (IVL) may increase treatment effectiveness without increasing risk of complications. This study was designed to evaluate the safety and effectiveness of IVL use after atherectomy in severely calcified coronary lesions as pre-treatment for drug-eluting stents (DES). The Dual-Prep registry is a multicenter, prospective registry of consecutive image-guided percutaneous coronary interventions (PCI). The primary effectiveness and safety endpoints were procedural success (residual stenosis\u2009&lt;\u200950% by quantitative coronary angiography) without an in-hospital major adverse cardiac event (MACE) and 30-day freedom from MACE, respectively. Baseline vessel calcification score and final DES expansion were evaluated by optical coherence tomography (OCT). A total of 118 patients with 120 lesions were enrolled at 20 sites. The calcification score of lesions after atherectomy by core-lab assessment was 4.0 in all cases. Rotational atherectomy was applied prior to IVL in 83.9% cases with mean burr size of 1.57\u2009\u00b1\u20090.20\u00a0mm; IVL was subsequently successfully delivered in all cases (mean balloon diameter 3.02\u2009\u00b1\u20090.45\u00a0mm), followed by DES deployment (mean diameter 3.19\u2009\u00b1\u20090.51\u00a0mm, length of 36.3\u2009\u00b1\u200916.0\u00a0mm). The primary efficacy and safety endpoints were met in 98.3% and 98.3% of cases, respectively. A DES expansion index\u2009&lt;\u20090.8 was seen in 42.2%, and an eccentricity index\u2009&lt;\u20090.7 was not observed in any patient. In severely calcified lesions, image-guided atherectomy followed by IVL lesion preparation demonstrated high procedural success rates and satisfactory non-eccentric stent expansion. This approach may be considered for lesions where an \u2018IVL-first\u2019 strategy may not be feasible. jRCT1032230384 (Oct 7, 2023).<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>Dual-Prep registry : atherectomy + IVL before DES implantation strategy for calcified lesion (Calc score \u2265 3 after atherectomy)<\/jats:p>","DOI":"10.1007\/s12928-025-01130-9","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T03:19:03Z","timestamp":1747019943000},"page":"553-564","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Dual-Prep registry: atherectomy devices and intravascUlAr lithotripsy for the PREParation of heavily calcified coronary lesions registry"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-3469","authenticated-orcid":false,"given":"Masato","family":"Nakamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehiro","family":"Kuriyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Kawasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Muramatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazushige","family":"Kadota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Ashikaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Otsuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeru","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raisuke","family":"Iijima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaku","family":"Nakazawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Shite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Honye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Ako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyoshi","family":"Yokoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kozuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromasa","family":"Otake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuho","family":"Masumura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomi","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Sotomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"1130_CR1","first-page":"160","volume":"28","author":"MS Lee","year":"2016","unstructured":"Lee MS, Shah N. 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Dr. Nakamura Masato received consulting fee from Shockwave Medical Japan K.K., honoraria from Boston Scientific Japan K.K., Terumo Co. and Shockwave Medical Japan K.K. and endowments from Boston Scientific Japan, K.K., and Terumo Co. Dr. Tanaka received honoraria from Shockwave Medical Japan K.K. Dr. Kawasaki received honoraria from Abbott Japan LLC., Boston Scientific Japan K.K., and Terumo Co. Dr. Muramatsu received honoraria from Abbott Japan LLC., Boston Scientific Japan K.K., Shockwave Medical Japan K.K., and Terumo Co. Dr. Otsuji received honoraria from Abbott Japan LLC., Boston Scientific Japan K.K., and Shockwave Medical Japan K.K. Dr. Ando received honoraria from Abbott Japan LLC. and Terumo Co. Dr. Ishida received honoraria from Abbott Japan LLC., Boston Scientific Japan K.K., and Terumo Co. Dr. Ito received honoraria from Boston Scientific Japan K.K., Abbott Japan LCC., and Terumo Co. Dr. Iijima received honoraria from Boston Scientific Japan K.K. and Terumo Co. Dr. Nakazawa received honoraria from Abbott Japan LLC., Boston Scientific Japan K.K., Terumo Co., and Shockwave Medical Japan K.K. Dr. Ako received honoraria from Shockwave Medical Japan K.K. Dr. Kozuma received honoraria from Boston Scientific Japan K.K., and Abbott Japan LLC and board member of Cardiovascular intervention and therapeutics. Dr. Otake received grants from Abbott Japan LLC. and honoraria from Abbott Japan LCC. and Terumo Co. Dr. Sotomi received grants from Abbott Japan LCC., Boston Scientific Japan K.K., and Terumo Co. Dr. Kuriyama, Dr. Yamazaki, Dr. Kadota, Dr. Ashikaga, Dr, Takahashi, Dr. Nakamura Shigeru, Dr. Shite, Dr. Honye, Dr. Yokoi, Mr. Masumura, and Dr. Yamada have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Approval was obtained from the ethics committee of Toho University Ohashi Hospital. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images in Fig.\u00a0\n                      \n                      .","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}