Implementation of a Standardized Algorithm for Coronary Calcification With Plaque Modification

Inclusion Criteria: 1. Documented myocardial ischaemia. 2. At least one moderate to severely calcified native coronary artery lesion confirmed by QCA and/or 60MHz HD IVUS, with the presence of significant calcium, ≥70% diameter stenosis by visual estimation (in a reference vessel diameter of ≥2.5mm and ≤4.0mm) and TIMI 3 flow at baseline that is suitable for PCI. a. Significant calcium at the target lesion site is defined as either: i. The presence of radiopacities involving both sides of the arterial wall \>10mm and involving the target lesion on angiography. or ii. The presence of \>270° arc of superficial calcium on HD intravascular imaging with a length \>5mm or the presence of 360° arc of calcium on HD intravascular imaging. \[1\] 3. It is possible to cross the calcified lesion with a coronary guidewire. 4. Age ≥ 18 years. 5. Patient is willing and able to comply with the study procedures and follow-up. Exclusion Criteria: 1. Patients with cardiogenic shock. 2. ST-segment elevation myocardial infarction. 3. Instent re-stenosis. 4. Stent thrombosis. 5. Coronary artery dissection. 6. Chronic total occlusion in a major artery. 7. Left ventricular ejection fraction ≤30%. Need for coronary artery bypass graft surgery. 9\. Documented allergy to everolimus or to any stent material 10. Any contraindication for dual antiplatelet therapy with aspirin and a P2Y12 inhibitor for at least 3 months (except for patients on oral anticoagulation). 11. For female, pregnancy, breastfeeding or intend to become pregnant within 1 year 12. Life expectancy \<1 year. 13. Participation in another study with an investigational product. 14. Inability to provide informed consent.