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Related Concept Videos

Imaging Studies for Cardiovascular System V: CT01:28

Imaging Studies for Cardiovascular System V: CT

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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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A Rat Carotid Artery Pressure-Controlled Segmental Balloon Injury with Periadventitial Therapeutic Application
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Intravascular lithotripsy in carotid disease.

Kathryn Dilosa1, Steven Maximus2, Misty D Humphries3

  • 1University of California, Davis Medical Center, Sacramento, CA, USA.

The Journal of Cardiovascular Surgery
|October 29, 2024
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Intravascular lithotripsy (IVL) combined with Transcarotid Artery Revascularization (TCAR) shows promise for treating calcified carotid stenosis. This approach may improve stent deployment and reduce embolization risks in high-risk patients.

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcarotid artery revascularization (TCAR) is a neuroprotective procedure for carotid stenosis, increasingly favored for high-risk patients.
  • Calcific atherosclerosis poses a challenge to TCAR, potentially impeding stent expansion and increasing embolization risk.
  • Intravascular lithotripsy (IVL), effective in coronary and peripheral arteries, offers a potential solution for calcific plaque modification.

Purpose of the Study:

  • To detail the procedural steps for utilizing Intravascular Lithotripsy (IVL) in conjunction with Transcarotid Artery Revascularization (TCAR).
  • To highlight the potential benefits of IVL in overcoming limitations posed by calcific atherosclerosis during TCAR.
  • To address the necessary adjustments for the off-label use of current lithotripsy balloons in carotid interventions.

Main Methods:

  • Procedural description of integrating IVL with TCAR.
  • Discussion of off-label use considerations for IVL devices in carotid arteries.
  • Emphasis on plaque modification to facilitate stent deployment.

Main Results:

  • IVL demonstrates potential in fracturing calcific plaque, thereby improving conditions for stent deployment during TCAR.
  • The combination approach may mitigate risks associated with severe calcification in carotid revascularization.
  • Procedural adjustments are necessary due to the current lack of carotid-specific IVL devices.

Conclusions:

  • IVL is a promising adjunct for TCAR in managing calcific carotid stenosis.
  • Further research and development of carotid-specific IVL devices are essential.
  • Additional safety and efficacy data are required before widespread adoption of IVL in TCAR.