Intravascular Lithotripsy of Aortic and Renal Lesions as a Therapeutic Tool for Pickering Syndrome: A Case Report

We report the case of a 73-year-old woman admitted with Pickering syndrome, a life-threatening condition characterized by recurrent flash pulmonary edema secondary to severe renovascular disease. Computed tomography angiography demonstrated an atrophic left kidney, a heavily calcified visceral aorta with a coral-reef morphology, and a near-occlusive stenosis of the right renal artery. Urgent endovascular treatment was performed with intravascular lithotripsy for plaque modification of the suprarenal aorta and the right renal artery, followed by renal artery stenting. The patient showed prompt clinical recovery, with resolution of pulmonary edema, stabilization of blood pressure, and improvement of renal function. This case illustrates the potential role of intravascular lithotripsy as a minimally invasive adjunct for managing severely calcified aorto-renal disease in high-risk patients, enabling endovascular treatment in otherwise challenging anatomy.