血管医学および外科ジャーナル

概要

Intravascular Lithotripsy to Facilitate Carotid Stenting

Kevin Kang1*, John Wilson2

Severe arterial calcification can make balloon and stent expansion challenging. Severely calcified lesions are more likely to undergo recoil after balloon expansion or stenting. Intravascular Lithotripsy (IVL) is a potential solution for severe calcification limiting stent expansion or recoil in the Internal Carotid Artery (ICA). IVL has been rarely tried in ICA territory. ICA endovascular intervention is unique due to high risk of stroke and use of distal protection is mandatory to qualify for procedure re-imbursement. IVL is not approved in the ICA territory and not approved for treating under expanded stents. But, traditional calcium de bulking devices like Rotational or orbital atherectomy are dangerous in ICA territory while calcium scoring devices might fail. IVL can modify calcified plaque without direct mechanism for embolization. There have been reports of application of IVL in carotid self-expanding stenting. We have recently reported our experience in a Case Report in the use of IVL to both successfully dilate under expanded stents and stop the repeated lesion and stent recoil. IVL barring some limitations of requiring prolonged balloon inflations and lack of enough long-term follow may be further studied in the treatment of under expansion as well as recoil of self-expanding stents in carotid circulation.