Intravascular Lithotripsy as Salvage Therapy for Heavily Calcified Carotid Artery Stenosis during Carotid Artery Stenting: A Case Report

Vollständiger Abstract

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Stroke remains a leading cause of death and disability worldwide. In appropriately selected patients with symptomatic carotid artery stenosis, carotid artery stenting (CAS) is an established strategy for stroke prevention. However, severe vascular calcification may limit adequate lesion preparation, resulting in suboptimal stent expansion, thereby compromising procedural success. Although intravascular lithotripsy (IVL) has emerged as a plaque-modification technique for heavily calcified vascular lesions, clinical experience in the carotid circulation remains limited. We report the case of an 83-year-old woman with calcified carotid lesions. symptomatic critical right internal carotid artery stenosis who underwent CAS. After unsuccessful lesion preparation with cutting balloon angioplasty, IVL was used as salvage therapy before stent deployment. IVL facilitated adequate plaque modification, allowing stent expansion and a satisfactory angiographic result following adjunctive post-dilation. The only procedural complication was transient bradycardia, which resolved promptly with atropine. The patient experienced no perioperative neurological complications and remained free of recurrent stroke during 12 months of follow-up. This case illustrates the potential role of IVL as a salvage strategy when conventional lesion preparation during CAS is unsuccessful and supports its consideration in selected patients with heavily calcified carotid lesions.