Diaz Orlando, Gerstner Saucedo Jochen, Carmona Isabel, Lumsden Alan B, Lengyel Balazs C
Department of Radiology, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA.
Advanced Imaging Lab, Department of Radiology, University of Colorado Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO 80045, USA.
Radiol Case Rep. 2025 Sep 15;20(12):5977-5983. doi: 10.1016/j.radcr.2025.08.087. eCollection 2025 Dec.
Intravascular lithotripsy (IVL), although considered off-label for carotid interventions, has proven to be beneficial for the treatment of heavily calcified lesions and may improve outcomes in select patients unsuitable for open repair. We present 3 consecutive cases of IVL-assisted carotid artery stenting (CAS) performed via transfemoral and transradial approaches in patients with severe internal carotid artery calcification. All patients were considered poor candidates for carotid endarterectomy (CEA). Technical success was achieved in all cases, with no neurological complications noted during the perioperative period, 30-day follow-up (with 6-month follow-up in 2 patients since 1 was lost to follow-up). All procedures were performed using distal filter protection alone without flow reversal, in contrast to most published series. IVL may broaden CAS applicability for patients with circumferential calcification and combined high anatomic/physiologic surgical risk who are not candidates for CEA. Further studies are warranted to evaluate long-term outcomes and optimal patient selection.
血管内碎石术（IVL）虽被视为颈动脉介入治疗的非适应证，但已证明对治疗严重钙化病变有益，且可能改善某些不适合开放修复患者的治疗效果。我们展示了3例连续通过股动脉和桡动脉途径进行IVL辅助颈动脉支架置入术（CAS）的病例，这些患者存在严重的颈内动脉钙化。所有患者均被认为不适合进行颈动脉内膜切除术（CEA）。所有病例均取得技术成功，围手术期未出现神经并发症，随访30天（2例患者随访6个月，1例失访）。与大多数已发表的系列研究不同，所有手术均仅使用远端滤网保护而未进行血流逆转。IVL可能会扩大CAS对那些存在环形钙化且解剖/生理手术风险高而不适合CEA的患者的适用性。有必要进行进一步研究以评估长期疗效和最佳患者选择。
