Intravascular lithotripsy-assisted carotid artery stenting in heavily calcified lesions: A case series

Figures

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  Fig. 1. (A,B) Diagnostic angiography demonstrating a heavily calcified plaque at the distal common carotid artery (CCA), indicated by yellow arrows, resulting in 80% stenosis by NASCET criteria. (C) Intravascular lithotripsy using a 7 mm x 60 mm ShockWave M5 balloon at the right carotid bifurcation (yellow arrow). (D) Angiographic appearance immediately after lithotripsy, showing persistent narrowing at the plaque site (yellow arrow) with the distal embolic protection device positioned beyond the lesion in the ICA (blue arrow). (E) Completion angiography after deployment of a 10 mm x 31 mm stent, showing resolution of the stenosis (yellow arrow).

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  Fig. 2. (A) Diagnostic angiography showing severe, calcified subtotal stenosis of the right internal carotid artery (ICA), indicated by the yellow arrow. (B–C) Angiographic images during intravascular lithotripsy using a 4 mm x 12 mm ShockWave M5 balloon, with the treated segment highlighted by yellow arrows. The embolic protection device is not visualized as it is positioned distally and (D) Completion angiography after deployment of a 10 mm x 31 mm stent, demonstrating restored luminal patency without complication (yellow arrow).

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  Fig. 3. (A) CTA reconstruction demonstrating a heavily calcified plaque at the origin of the left internal carotid artery (ICA), causing approximately 80% stenosis by NASCET criteria (yellow arrow). (B) Digital subtraction angiography confirming the location and severity of the calcified lesion (yellow arrow). (C) Intravascular lithotripsy performed using a 4 mm × 12 mm ShockWave C2+ balloon (yellow arrow) with the distal embolic protection device positioned beyond the lesion in the ICA (blue arrow) and (D) Completion angiography following deployment of an 8 mm x 29 mm stent, demonstrating successful luminal restoration (yellow arrow).