Abstract
A 49-year-old female with severe kidney dysfunction presented with an acute coronary syndrome. After angiography demonstrated severe disease in the left anterior descending and obtuse marginal arteries, she underwent staged percutaneous intervention with intravascular lithotripsy under fluoroscopic and intravascular ultrasound guidance with the use of zero contrast. She did well and went home 3 days post procedure with no deterioration in her renal function. This demonstrates the feasibility of complex coronary intervention with no contrast requirement.