Evans Alexander R, Kharbat Abdurrahman F, Gierman Joshua L, Shakir Hakeem J
Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Department of Vascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
SAGE Open Med Case Rep. 2024 Dec 6;12:2050313X241297217. doi: 10.1177/2050313X241297217. eCollection 2024.
calcific carotid stenosis is becoming more common as the advanced-age population grows, requiring new therapeutic approaches. As such, transcarotid arterial revascularization is gaining significant popularity in the management of carotid stenosis due to low rates of perioperative complications and optimal clinical outcomes. In addition, intravascular lithotripsy has shown promise in safely facilitating the success of endovascular procedures in the context of calcified lesions. The combination of neuroprotective technology offered by transcarotid arterial revascularization and circumferential plaque remodeling by intravascular lithotripsy has been utilized for complex lesions. We present two cases of symptomatic calcific carotid stenosis treated with intravascular lithotripsy before transcarotid arterial revascularization. A 4 × 40 mm lithotripsy balloon delivered shockwaves at two and four atmospheres over a 0.014 wire. Transcarotid arterial revascularization was successfully completed without complications, and luminal patency was observed in both patients. Calcific carotid stenosis was effectively treated with intravascular lithotripsy before transcarotid arterial revascularization, resulting in optimal safety and clinical recovery. Thus, when combined with novel shockwave technology, the neuroprotective effect of flow reversal in transcarotid arterial revascularization procedures demonstrates promise in maintaining safety while providing a novel treatment technique for high-risk patients with calcific cervical internal carotid artery stenosis.
随着老年人口的增加，钙化性颈动脉狭窄越来越普遍，这就需要新的治疗方法。因此，经颈动脉血管重建术因其围手术期并发症发生率低且临床效果理想，在颈动脉狭窄的治疗中越来越受到欢迎。此外，血管内碎石术已显示出有望在钙化病变的情况下安全地促进血管内手术的成功。经颈动脉血管重建术提供的神经保护技术与血管内碎石术实现的环形斑块重塑相结合，已被用于治疗复杂病变。我们报告两例有症状的钙化性颈动脉狭窄病例，在经颈动脉血管重建术前接受了血管内碎石术治疗。一个4×40毫米的碎石球囊通过0.014英寸的导丝在两个和四个大气压下释放冲击波。经颈动脉血管重建术成功完成，无并发症发生，两名患者均观察到管腔通畅。在经颈动脉血管重建术前，血管内碎石术有效地治疗了钙化性颈动脉狭窄，实现了最佳的安全性和临床恢复。因此，当与新型冲击波技术相结合时，经颈动脉血管重建术中血流逆转的神经保护作用在维持安全性的同时，为患有钙化性颈内动脉狭窄的高危患者提供了一种新的治疗技术，显示出了前景。
