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To the Editor, Treatment of heavily calcified coronary artery disease (CAD) remains a technical challenge since a significant number of patients require some type or form of advanced plaque modification procedure in the cath lab. Therefore, interventional cardiologists should be aware of the complete array of plaque modification techniques available to prepare vessels to facilitate optimal stent deployment and expansion.1 In the presence of proximal calcified disease in tortuous vessels, orbital atherectomy can be used as an alternative to rotational atherectomy thanks to its greater stability with reverse ablation, improved ease of use, and convenience as a result of a single-size burr that can be used to treat a wide range of vessel profiles. In addition, it appears to have a similar safety profile compared to rotational atherectomy.2 We herein describe a case of 3-vessel proximal heavily calcified CAD where we demonstrate the feasibility of using orbital atherectomy to prepare all 3 epicardial vessels using a one-size burr guided by co-registered intravascular ultrasound (IVUS) and physiology prior to complete percutaneous revascularization in a single-staged procedure. This is the case of a 73-year-old man with hypertension, type II diabetes mellitus, severe chronic obstructive pulmonary disease (forced expiratory volume in 1 second [FEV1] of...