Intravascular Lithotripsy Facilitated Percutaneous Endovascular Intervention of the Aortic Arch: A Single-Center
Brian C Case1, Charan Yerasi1, Brian J Forrestal1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Background:
Intravascular lithotripsy (IVL) (Shockwave Medical, Inc., Fremont, California, USA) is a novel technology used to modify heavily calcified atherosclerotic plaque in vessels to help facilitate percutaneous coronary intervention and has been shown to be effective in treating critical lesions within the lower limbs. In addition, studies are currently underway evaluating IVL's feasibility in de novo calcified stenotic coronary arteries before stenting. The use and associated complications of IVL in other vascular territories are underreported. We report our institution's initial experience using IVL for the treatment of complex, heavily calcified lesions within the aortic arch vessels.
Methods And Results:
We treated five patients with IVL of the aortic arch vessels, including the carotid (2), subclavian (2), and innominate arteries. Four of the five patients underwent successful IVL treatment and intervention without complications. One patient (carotid intervention) developed acute right eye blindness post-procedure, thought to be due to an embolic plaque, which was successfully treated with tissue plasminogen activator and intravenous heparin.
Conclusion:
IVL offers promising technology to facilitate the treatment of complex lesions in the vessels of the aortic arch. We do not promote the use of IVL but promote prospective clinical trials to assess the safety and efficacy of this technology in this vascular territory.
