Shockwave intravascular lithoplasty for the treatment of calcified carotid artery stenosis: A very early single-center experience

Endovascular treatment of calcified carotid disease represents one of the main challenges for the interventionalists. Plaque calcium load is one of the most important factors affecting the risk of procedural complications. A new tool called Shockwave intravascular lithotripsy (S-IVL; Shockwave Medical, Inc.) has been recently approved for the treatment of heavily calcified coronary and lower limb arteries but minimal data exist about the treatment of carotid arteries. We report our early experience of carotid stenting using S-IVL. We report two cases of symptomatic patients with severely calcified carotid artery diseases who were turned down for vascular surgeries. The first case was successfully performed through radial access using a distal cerebral embolic protection device in the context of contralateral carotid occlusion. In the second case, a very tight and calcified left internal carotid artery stenosis was successfully treated through femoral access using a proximal cerebral protection device. In both cases, advanced imaging confirmed effective calcium debulking and good stent expansion after IVL treatment. S-IVL effectiveness basically resides in integrating the effect of balloon angioplasty with the calcium-disrupting power of sonic pressure waves. This could be able to minimize the risk of cerebral embolization due to aggressive conventional balloon predilatation or poststenting dilatation usually needed to obtain an adequate luminal gain in carotid stenting. According to our small case series, the use of S-IVL for the treatment of heavily calcified carotid artery lesions seems to be helpful in this particular setting.