Intravascular lithotripsy in calcified carotid stenosis: technical and clinical outcomes

Carotid artery stenosis (CAS) is a major cause of stroke, disability, and mortality worldwide. While medical therapy and revascularization remain the cornerstones of management, both surgical and endovascular approaches can be limited by complex anatomy and heavily calcified plaques, which increase procedural risk. Intravascular lithotripsy (IVL), originally developed for coronary and peripheral interventions, has recently emerged as a potential strategy for plaque modification in CAS. By delivering localized shockwave pulses, IVL fractures vascular calcium, facilitating safer angioplasty and stent deployment. However, its use in CAS remains off-label and poorly described.

A systematic search of PubMed, Google Scholar, and Embase was conducted in September 2025 in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included patients with CAS undergoing IVL with reported procedural success and/or clinical outcomes. Risk of bias was assessed using the Joanna Briggs Institute (JBI) appraisal tools.

Fifteen studies comprising 120 patients were included. The mean age ranged from 50 to 82 years, and the degree of stenosis from 70%-95%. Technical success was reported in 100% of cases. Across the pooled cohort, 101 of 120 patients (84.2%) achieved residual stenosis ≤30%. Seven patients (5.8%) experienced ipsilateral stroke or transient ischemic attack within 30 days.

IVL for CAS is an emerging therapy demonstrating consistent technical feasibility and favorable short-term safety across published studies. These findings suggest that IVL may benefit patients with complex calcified plaques at high risk for standard revascularization; however, randomized controlled trials are needed to confirm its role in clinical practice.