University of California, Davis Medical Center, Sacramento, CA, USA.
University of Texas at Houston Herman Hospital, Houston, TX, USA.
J Cardiovasc Surg (Torino). 2024 Oct;65(5):476-481. doi: 10.23736/S0021-9509.24.13190-4. Epub 2024 Oct 29.
Transcarotid artery revascularization (TCAR) is a hybrid approach with neuroprotective flow reversal for treating carotid stenosis. Providers are increasingly choosing it for patients, especially those at high risk for carotid endarterectomy (CEA). However, TCAR's efficacy is limited by calcific atherosclerosis, which can hinder stent expansion and increase the risk of perioperative embolization. Intravascular lithotripsy (IVL) is introduced as a promising solution to this issue. Initially developed for coronary and peripheral vascular diseases, IVL uses acoustic pressure waves to fracture calcific plaque, enabling better stent deployment. This work details the procedural steps for IVL in conjunction with TCAR, emphasizing its potential benefits and the adjustments needed due to the off-label use of currently available lithotripsy balloons. While IVL shows promise in addressing calcific atherosclerosis in carotid interventions, further research and development of carotid-specific devices are necessary. There is also the need for additional data on the safety and efficacy of this approach before it can be widely adopted.
经颈动脉动脉血运重建术（TCAR）是一种具有神经保护血流逆行的杂交方法，用于治疗颈动脉狭窄。提供者越来越多地选择为高颈动脉内膜切除术（CEA）风险的患者进行此治疗。然而，TCAR 的疗效受到钙化粥样硬化的限制，这会阻碍支架扩张并增加围手术期栓塞的风险。血管内碎石术（IVL）被引入作为解决此问题的有前途的方法。最初为冠状动脉和外周血管疾病开发的 IVL 使用声压波来碎裂钙化斑块，从而可以更好地部署支架。这项工作详细介绍了与 TCA 联合使用 IVL 的程序步骤，强调了其潜在的益处以及由于目前可用的碎石球囊的标签外使用而需要进行的调整。虽然 IVL 显示出在解决颈动脉介入治疗中的钙化粥样硬化方面有希望，但仍需要对颈动脉专用设备进行进一步的研究和开发。在广泛采用之前，还需要更多关于这种方法的安全性和有效性的数据。
