Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
Vascular and Endovascular Surgery Division, Department of Surgery "Paride Stefanini," Policlinico Umberto I, "La Sapienza" University of Rome, Italy.
J Endovasc Ther. 2021 Feb;28(1):93-99. doi: 10.1177/1526602820954244. Epub 2020 Sep 1.
To report the use of intravascular lithotripsy (IVL) in the treatment of calcified carotid artery lesions.
The records of 21 high-surgical-risk patients (mean age 75.1±8.1 years; 17 men) who were treated at 8 centers for carotid artery stenosis ≥70% were retrospectively reviewed. Twelve patients had a history of cerebrovascular disease. All patients had heavily calcified carotid artery lesions: 19 de novo and 2 in-stent restenoses (ISR). The mean baseline stenosis was 82.3%±9.7%. IVL was utilized at the discretion of the operator, followed by balloon angioplasty. Embolic protection devices were used in all cases.
In 19 patients, IVL was followed by stent implantation; the 2 ISR lesions were dilated only. The mean IVL balloon diameter was 4.64±1.13 mm, and the mean number of IVL pulses applied was 67.2±61.4 (range 10-180). All procedures were technically successful (<30% residual stenosis). No patients developed symptomatic bradycardia or hypotension due to IVL, and there were no adverse events associated with IVL delivery. All patients were discharged on dual antiplatelet therapy. Seventeen days after the procedure, 1 patient experienced an ischemic stroke that was deemed due to aortic arch manipulation during transfemoral access. Carotid duplex ultrasound examination identified significant restenosis (>70%) in 1 asymptomatic patient at 12 months after the index procedure. No patients required reintervention during a median follow-up of 6 months (range 1-12).
This preliminary experience demonstrates that IVL can be a safe and effective approach for the management of severely calcified carotid lesions. Further research is warranted to determine the longer-term safety and efficacy of IVL for dilation of calcified carotid artery lesions as an adjunct to carotid artery stenting.
报告血管内碎石术（IVL）在治疗钙化颈动脉病变中的应用。
回顾性分析了 8 个中心治疗的 21 例高手术风险患者（平均年龄 75.1±8.1 岁，17 例男性）的记录，这些患者的颈动脉狭窄≥70%。12 例患者有脑血管疾病史。所有患者均有严重钙化的颈动脉病变：19 例为新发病变，2 例为支架内再狭窄（ISR）。基线狭窄程度平均为 82.3%±9.7%。IVL 可由术者决定使用，随后进行球囊血管成形术。所有病例均使用了栓塞保护装置。
19 例患者接受了 IVL 后支架植入术，2 例 ISR 病变仅进行了扩张。IVL 球囊的平均直径为 4.64±1.13mm，应用 IVL 脉冲的平均次数为 67.2±61.4（范围 10-180）。所有操作均技术成功（残余狭窄<30%）。没有患者因 IVL 出现症状性心动过缓和低血压，也没有与 IVL 输送相关的不良事件。所有患者均在双联抗血小板治疗下出院。术后 17 天，1 例患者发生缺血性卒中，认为是经股动脉入路时主动脉弓操作所致。颈动脉双功能超声检查在 17 例无症状患者中发现 12 个月时指数手术后存在明显再狭窄（>70%）。在中位随访 6 个月（范围 1-12）期间，没有患者需要再次介入治疗。
初步经验表明，IVL 治疗严重钙化颈动脉病变是一种安全有效的方法。需要进一步研究以确定 IVL 扩张钙化颈动脉病变作为颈动脉支架置入术的辅助手段的长期安全性和有效性。
