Intravascular lithotripsy-assisted carotid artery stenting in heavily calcified lesions: A case series

Intravascular lithotripsy (IVL), although considered off-label for carotid interventions, has proven to be beneficial for the treatment of heavily calcified lesions and may improve outcomes in select patients unsuitable for open repair. We present 3 consecutive cases of IVL-assisted carotid artery stenting (CAS) performed via transfemoral and transradial approaches in patients with severe internal carotid artery calcification. All patients were considered poor candidates for carotid endarterectomy (CEA). Technical success was achieved in all cases, with no neurological complications noted during the perioperative period, 30-day follow-up (with 6-month follow-up in 2 patients since 1 was lost to follow-up). All procedures were performed using distal filter protection alone without flow reversal, in contrast to most published series. IVL may broaden CAS applicability for patients with circumferential calcification and combined high anatomic/physiologic surgical risk who are not candidates for CEA. Further studies are warranted to evaluate long-term outcomes and optimal patient selection.