Coronary calcification is a significant predictor of major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI). This is largely due to the challenges it presents in device delivery, expansion, and apposition, which can predispose stent failure. Recently, intravascular lithotripsy (IVL) has emerged as a novel approach to modifying calcified coronary plaques, overcoming many of the limitations associated with conventional techniques such as non-compliant balloons, cutting and scoring balloons, and rotational/orbital atherectomy. This review discusses the growing body of evidence supporting the use of IVL as a frontline strategy for managing severely calcified coronary arteries prior to stenting. The review highlights the mechanism of action, clinical efficacy, and safety profile of IVL in the treatment of calcified lesions, comparing it to other available methods. Additionally, the review examines clinical outcomes associated with IVL, including its impact on stent expansion, procedural success, and reduction in adverse events. As the use of IVL becomes more widespread, its role in the management of calcified coronary arteries continues to evolve, offering promising results and shaping future guidelines for PCI.