Background: Coronary Because calcification makes stent failure more likely and hinders device distribution, expansion, and apposition, it is a significant predictor of major adverse cardiac events (MACE) during percutaneous coronary intervention (PCI). The more popular methods, such as percutaneous transluminal coronary angioplasty (PTCA) with non-compliant (NC) balloons, cutting-/scoring-balloons, and rotational/orbital atherectomy, have their limitations. Intravascular lithotripsy (IVL) is a relatively new method that can modify calcified coronary plaques. Despite applying high pressure, NC balloon dilatation is often unable to provide the required force for rupturing calcifications. Because calcified lesions are generally eccentric, balloon dilatation often disrupts or dissects healthy intima or fibrous plaques instead of modifying calcified regions inside the artery. Even though they can debulk the lesion more intensively than NC balloons, cutting and scoring balloons still have the same restriction. The most effective methods for modifying calcified plaques before IVL, such as rotational or orbital atherectomy, have their limitations owing to guidewire bias. This bias can cause inhomogeneous ablation, which leaves large areas of the calcified plaques unmodified, especially in eccentric lesions. Optimal lesion modification strategies, such as intravascular ligation (IVL), rotational atherectomy (RA), or orbital atherectomy (OCT), may only be determined with the use of intravascular ultrasonography (IVUS) or optical coherence tomography (OCT). Review objective: There is mounting evidence that intravenous ligation (IVL) should be the first line of defense against newly formed, highly calcified coronary arteries, and this review paper addresses that evidence. stenting.