Cardiovascular Department, Universitary Hospital "Policlinico P. Giaccone", Palermo, Italy.
Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy.
Catheter Cardiovasc Interv. 2020 Nov;96(6):E608-E613. doi: 10.1002/ccd.28963. Epub 2020 May 7.
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.
血管内治疗钙化性颈动脉疾病是介入医生面临的主要挑战之一。斑块钙负荷是影响手术并发症风险的最重要因素之一。一种名为 Shockwave 血管内碎石术（S-IVL；Shockwave Medical，Inc.）的新工具最近已获准用于治疗重度钙化的冠状动脉和下肢动脉，但关于颈动脉治疗的数据很少。我们报告了使用 S-IVL 治疗颈动脉狭窄的早期经验。我们报告了两例因严重钙化性颈动脉疾病而被拒绝血管手术的有症状患者的病例。第一例病例通过桡动脉入路成功进行，在对侧颈动脉闭塞的情况下使用了远端脑保护装置。在第二例病例中，通过股动脉入路使用近端脑保护装置成功治疗了非常紧且钙化的左侧颈内动脉狭窄。在这两种情况下，高级成像均证实了 IVL 治疗后有效的钙减容和良好的支架扩张。S-IVL 的有效性主要在于将球囊血管成形术的效果与声压波的钙破坏能力相结合。这可以最大限度地降低由于通常需要进行激进的常规球囊预扩张或支架内后扩张以在颈动脉支架置入术中获得足够的管腔增益而导致的脑栓塞风险。根据我们的小病例系列，在这种特殊情况下，使用 S-IVL 治疗重度钙化性颈动脉病变似乎是有帮助的。
