Mitchell Macy, Verhey Leonard H, Taylor Naveen, Sewell Andrea, Orozco Andres Restrepo, Mazaris Paul
Department of Medicine, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States.
Department of Neurosurgery, Corewell Health West, Grand Rapids, MI, United States.
Front Neurol. 2025 Sep 3;16:1634201. doi: 10.3389/fneur.2025.1634201. eCollection 2025.
In patients with circumferential heavily calcified carotid stenosis, conventional carotid artery stenting (CAS) has its limitations, and carotid endarterectomy may be contraindicated. Intravascular lithotripsy (IVL) as an adjunct to CAS may be well suited for this subset of patients. We provide a technical report and series of five patients with severe, calcified carotid stenosis who underwent adjunctive IVL with CAS at our tertiary center.
All patients who underwent CAS with adjunctive IVL for severe carotid calcific stenosis at our center were included. All data were extracted from the electronic medical record and the departmental database. Data were synthesized in accordance with Preferred Reporting of Case Series in Surgery (PROCESS) guidelines.
Five patients underwent CAS with adjunctive IVL for severe carotid stenosis between November 2022 and August 2024. The mean age at time of the procedure was 78.8 (SD 4.9); 80% were male. Patients presented with symptomatic stenosis, ranging from 50 to >95%. Symptoms included visual deficits (60%), hemiparesis (40%), facial droop (40%), and dysarthria (40%). All patients underwent post-procedural duplex ultrasound, which demonstrated resolution or significant reduction of stenosis. There were no clinical thromboembolic events. All patients have been followed in our comprehensive stroke program. Two patients died from causes unrelated to the procedure.
Adjunctive intravascular lithotripsy in patients with severe, circumferential calcified stenosis is a novel technique that has shown promising preliminary results. This application of intravascular lithotripsy warrants further investigation.
在患有环形重度钙化颈动脉狭窄的患者中，传统的颈动脉支架置入术（CAS）存在局限性，颈动脉内膜切除术可能为禁忌。血管内碎石术（IVL）作为CAS的辅助手段可能非常适合这类患者。我们提供一份技术报告以及在我们三级中心接受CAS联合IVL治疗的5例重度钙化颈动脉狭窄患者的病例系列。
纳入在我们中心接受CAS联合IVL治疗重度颈动脉钙化狭窄的所有患者。所有数据均从电子病历和科室数据库中提取。数据根据外科病例系列报告的首选格式（PROCESS）指南进行汇总。
2022年11月至2024年8月期间，5例患者接受了CAS联合IVL治疗重度颈动脉狭窄。手术时的平均年龄为78.8岁（标准差4.9）；80%为男性。患者表现为有症状的狭窄，范围从50%至>95%。症状包括视力缺损（60%）、偏瘫（40%）、面部下垂（40%）和构音障碍（40%）。所有患者术后均接受了双功超声检查，结果显示狭窄得到缓解或显著减轻。无临床血栓栓塞事件发生。所有患者均在我们的综合卒中项目中接受随访。2例患者死于与手术无关的原因。
在重度环形钙化狭窄患者中应用辅助血管内碎石术是一种新技术，已显示出有前景的初步结果。血管内碎石术的这种应用值得进一步研究。
