Calcified nodule, which has been known as the advanced stage of coronary calcification, is becoming frequently reported in intracoronary imaging studies [ ]. Pathophysiologic and prognostic meanings are not yet completely understood although it has been suggested a relation between in-stent calcified nodule and in-stent thrombosis [ , ]. Rotational atherectomy is the usual proposed treatment in non-LM vessels but outcomes appeared suboptimal [ ], claiming for alternative strategies.