Abstract 010: Adjunctive Intravascular Lithotripsy forHeavilyCalcified Carotid Stenosis: A Multicenter Experience & Technical Description
BackgroundIntravascular lithotripsy (IVL) has increasingly been recognized as an effective intervention for heavily calcified atherosclerotic stenosis within coronary and peripheral vascular territories. Heavily calcified carotid stenosis (HCCS) has been considered an exclusion criteria for carotid...
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| Published in: | Stroke: vascular and interventional neurology Vol. 4; no. S1 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Phoenix
Wiley Subscription Services, Inc
01-11-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | BackgroundIntravascular lithotripsy (IVL) has increasingly been recognized as an effective intervention for heavily calcified atherosclerotic stenosis within coronary and peripheral vascular territories. Heavily calcified carotid stenosis (HCCS) has been considered an exclusion criteria for carotid angioplasty and/or stenting (CAS), amenable to only carotid endarterectomy. We present a preliminary retrospective dual‐center experience utilizing the Shockwave S4 IVL system (Shockwave® Medical Inc.) as an adjunct to CAS for HCCS.MethodsCharts of consecutive patients with symptomatic or asymptomatic HCCS undergoing IVL+CAS were reviewed for demographic, imaging, procedural, and outcome data. Primary endpoint was composite major adverse event (MAE), defined as death, ipsilateral stroke, or myocardial infarction (MI) within 30 days of IVL+CAS. Secondary endpoints included technical and procedural success, residual stenosis, and in‐stent restenosis.ResultsFifteen patients underwent 17 IVL+CAS procedures. Thirteen were performed for de novo HCCS and 4 for heavily calcified ISR. Seven addressed symptomatic disease. All procedures were performed under conscious sedation through the femoral route using a balloon guide catheter. Median pre‐IVL+CAS stenosis by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria was 73% [IQR:60‐80%]. Technical success was achieved in 100% of cases, encompassing use of IVL, CAS, and EPD. Median post‐IVL+CAS residual stenosis was 27% [IQR:12‐33%] reaching <50% residual stenosis in all, resulting in a 100% (95% confidence interval [CI]: 80.5‐100%) procedural success rate. Five patients required in‐hospital dopamine infusion for postprocedural hypotension. No periprocedural ipsilateral strokes occurred. The MAE rate was 6.7% (95% CI:0.2‐32, p=0.001) accounting for 1 MI resulting in death. Additionally, 1 case of ISR (6.3%; 95%CI:0.2‐30.2%) identified 160 days post‐IVL+CAS was retreated with angioplasty.ConclusionCAS with adjunctive IVL was safe and effective for treating symptomatic and asymptomatic HCCS, achieving high rates of freedom from MAE. IVL has potential to expand the role of CAS in difficult‐to‐treat HCCS previously only amenable to carotid endarterectomy. |
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| ISSN: | 2694-5746 2694-5746 |
| DOI: | 10.1161/SVIN.04.suppl_1.010 |