Intravascular lithotripsy for the treatment of severely calcified carotid lesion: An early single center experience

Abstract

Although endovascular carotid treatment became more efficient and prevalent, severely calcified carotid lesions remain one of the most challenging lesions and a strong predictor of complications for both endovascular and surgical treatment. We sought to evaluate the effectiveness and safety of intravascular lithotripsy (IVL) using Shockwave balloon device to treat severely calcified carotid lesions. We enrolled five patients with symptomatic severely calcified carotid lesions who were selected for endovascular treatment using IVL. Final stent expansion and calcium load plaque were evaluated using angiographic, ultrasound and intravascular imaging. A total of 5 patients were included in our study. The mean age was 79.6 years, all patients had at least one cardiovascular risk factor. Two patients had bilateral carotid lesions and three had concomitant coronary lesions. All procedures were done through a femoral access and cerebral protection device was used in all cases. Balloon pre-dilatation was performed in all cases with a small coronary balloon before crossing the lesion with the 5 × 60 mm Shockwave balloon. Four cycles of 30 pulses were used in 4 patients and five cycles in one patient. Post dilatation was performed with good balloon expansion in all cases. Good stent expansion was obtained in all cases. Angiographic and vascular ultrasound results showed successful debulking and calcified plaque disrupt. Intravascular imaging (2/5 patients) confirmed calcium disrupt and good stent apposition. There were no procedural complications. Post-procedural cerebral CT showed no stroke for all patients. Our early experience showed that IVL for the treatment of heavily calcified carotid lesions is feasible and safe following a rigorous technique and a good patient selection.