Paul Lavigne, MD, Paul Mahoney, MD, and Matt Summers, MD, present this live Protected PCI case from Sentara Heart Hospital in Norfolk, Virginia. The case features transcaval access, Shockwave intravascular lithotripsy, and rotational atherectomy in a challenging intervention on a long, heavily calcified LAD segment. Seth Bilazarian, MD, with panelists Ernesto Ruiz-Rodriguez, MD, and Lorenzo Azzalini, MD, and Haroon Faraz, MD, provide commentary as the treatment plan for this case evolves.