Intravascular lithotripsy in carotid disease

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.