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Background and Importance Calcified coronary lesions complicate percutaneous interventions and increase cardiovascular risk. Specific lesion preparation is essential, with rotational atherectomy and intravascular lithotripsy now central approaches. Their rising use raises medico-economic concerns.Aim and Objectives This study assessed the medico-economic impact of Rotapro and Shockwave in complex coronary lesions, focusing on device consumption, related costs, and compliance with CE-marked indications.Material and Methods A retrospective observational study was carried out in 2024. Device consumption and costs were collected for Rotapro burrs and Shockwave catheters. Nineteen Rotapro and nineteen Shockwave procedures were reviewed for clinical indications versus CE marking, as well as the homogeneous group of stays (GHS) associated with each procedure. Data were collected and analysed using Pharma (a medication consumption tracking software), Qcare (an electronic medical record system), and Excel.Results In 2024, 98 Rotapro burrs and 32 Shockwave catheters were used. CE-compliant indications were found in 74% of Rotapro cases (mean age 73 years) and 68% of Shockwave cases (mean age 72 years). The mean GHS was €2,220 for Rotapro and €1,974 for Shockwave . Additional sterile medical devices cost €372 on average for Rotapro (excluding the generator) and €36 for Shockwave .Conclusion and Relevance Adoption of both devices has grown since 2021, but their economic profiles diverge: Shockwave (€2,160 per device) exceeds the average GHS tariff, while Rotapro benefits from reimbursement through the List of Reimbursable Products and Services (LPPR). These findings emphasise the need to optimise valorisation through the French Medical Information System (PMSI), raise surgeons’ awareness of costs, and further explore compliance with CE-marked indications, given that nearly one-quarter of prescriptions were non-conforming.Conflict of Interest No conflict of interest