ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1634201
Intravascular lithotripsy followed by angioplasty and stenting for severely calcified carotid artery stenosis: a technical note and case series
Provisionally accepted
- 1Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, United States
- 2Department of Neurosurgery, Corewell Health West, Grand Rapids, United States
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Purpose: 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.Methods: 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 departmental database. Data were synthesized in accordance with Preferred Reporting of Case Series in Surgery (PROCESS) guidelines.Results: 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 in stenosis. There were no clinical thromboembolic events. All patients have been followed in our comprehensive stroke program. Two patients died secondary to 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.
Keywords: balloon angioplasty, high-energy shock wave, Carotid Stenosis, Lithotripsy, case series
Received: 23 May 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Mitchell, Verhey, Taylor, Sewell, Restrepo Orozco and Mazaris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Macy Mitchell, Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, United States
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