In this month's issue of Cardiovascular Revascularization Medicine Mattesini and colleagues report their findings from a single-center analysis of patients treated with intravascular lithotripsy (IVL) with intravascular imaging-guided percutaneous coronary intervention (PCI). This study highlights the excellent safety profile of IVL and is promising for the potential increased utilization of IVL, given the current dearth of lesion preparation used in real-world practice.