Intravascular lithotripsy to facilitate transcarotid artery revascularization in patients with heavily calcified carotid arteries

Transcarotid artery revascularization (TCAR) is an accepted (and approved) treatment for carotid artery stenosis in high-risk patients, and now standard risk patients under the guidelines of the recent CMS National Coverage Determination. However, it's applicability is limited by anatomic criteria, such as heavily calcified internal carotid arteries. We retrospectively reviewed two patients at our institution with heavily calcified internal carotid artery plaque who underwent intravascular lithotripsy and TCAR. These two cases demonstrate the feasibility of lithotripsy to modify heavy, calcified plaque prior to TCAR for patients at high risk for carotid endarterectomy.