Shockwave Lithotripsy for Severe Calcified Extracranial Vertebral and Carotid Disease Treated With Percutaneous Stenting

BACKGROUND: Patients harboring heavily calcified concentric or eccentric type lesions in the carotid or vertebral artery pose a challenge in placing a stent to reduce the lesion. These lesions yield suboptimal results due to poor stent expansion. Shockwave lithotripsy offers a potential solution for achieving luminal gain. METHODS: We present a retrospective study of all patients at our institution who were treated with lithotripsy for extracranial carotid or vertebral artery stenosis associated with heavily calcified lesions from July 2022 to February 2026. Data were maintained in our procedural database and retrospectively analyzed for patients treated with lithotripsy. All consecutive patients were analyzed for demographic information, procedural data, perioperative complications, and 6-month midterm follow-up imaging for restenosis. RESULTS: A total of 41 patients (8 vertebral artery lesions and 33 carotid lesions) were treated with intravascular lithotripsy at our institution between July 2022 and February 2026. The mean age for the cohort was 70.7 ± 8.7. The mean lesion pretreatment for the carotid stenosis was 77 ± 13% and for the vertebral artery treated patients 81 ± 11%. All patients were successfully treated with stenting and lithotripsy, and the mean stenosis posttreatment was 15 ± 14% for the carotid stenosis and 8 ± 5% for the vertebral artery lesions. There were 2 groin complications (5%) with femoral artery pseudoaneurysms treated with thrombin injection and 1 perioperative stroke (3%) secondary to a dissection in the carotid stent cohort. CONCLUSIONS: The current study demonstrates the feasibility of lithotripsy for heavily calcified lesions treated with transfemoral stenting. Future prospective core laboratory adjudicated studies are warranted to determine the efficacy of this technique.