The index of microcirculatory resistance (IMR) is an intracoronary wire-based measure of coronary microvascular function widely used in clinical practice [ ]. In patients with chronic coronary syndrome undergoing PCI, abnormal postprocedural IMR (>25) occur in approximately 25 % of patients, and is associated with adverse clinical outcomes [ , ]. Intravascular lithotripsy (IVL) is a recent technology developed to facilitate PCI in severely calcified coronary lesions. IVL addresses one of the limitations of rotational atherectomy i.e., debris embolization that might impair adequate microvascular function. However, the potential protective effect of IVL on the coronary microcirculation has not been explored. The aim of this pilot study was to evaluate coronary microvascular status using IMR after IVL assisted PCI. This study was a prospective, multicenter, investigator-initiated, single-arm, open-label pilot study ( NCT05134051 ). Patients with chronic coronary syndromes and severely calcified lesions referred for percutaneous revascularization facilitated by IVL (Shockwave Medical Inc., Santa Clara, CA, USA) were included.