Key result
Intravascular lithotripsy was successfully utilized to treat highly calcified carotid lesions before transcarotid artery revascularization in a high-risk surgical patient.
Why the study?
Heavily calcified lesions have historically been a relative contraindication for carotid stenting, presenting a challenge for patients who are high-risk surgical candidates.
Case Report (n=1)
Intravascular lithotripsy may be a feasible adjunctive therapy to facilitate transcarotid artery revascularization in patients with heavily calcified carotid lesions who are high-risk for surgery.
May support feasibility of lithotripsy before transcarotid revascularization in calcified lesions; leaves open need for prospective validation.
Transcarotid artery revascularization (TCAR) with dynamic flow reversal has been shown to be safe and effective in preventing stroke during carotid artery stenting (CAS), and has offered a less invasive option for carotid revascularization. Heavily calcified lesions has been a relative contraindication for carotid stenting in the past, although the use of intravascular lithotripsy (IVL)- a process of sonic pressure that fractures the calcium deposits has been shown to be effective in treating calcified lesions in arteries. When compared to carotid endarterectomy, TCAR has been shown to have similar complication rates for stroke and mortality and fewer complications when compared to transfemoral carotid artery stenting Herein, we describe a case of utilizing IVL to treat highly calcified carotid lesions before TCAR for a patient who otherwise would be a high-risk surgical patient.
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Nagarsheth et al. (2021) conducted a case report in High grade carotid artery stenosis with heavily calcified lesions (n=1). Intravascular lithotripsy (IVL) before transcarotid artery revascularization (TCAR) was evaluated. Intravascular lithotripsy was successfully utilized to treat highly calcified carotid lesions before transcarotid artery revascularization in a high-risk surgical patient.
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