Heavily Calcified Symptomatic Carotid Stenosis Treated With Off-Label Use of Lithotripsy Balloon Plus Stenting: 2-Dimensional Operative Video

Severe symptomatic carotid artery stenosis poses a significant risk for recurrent strokes. Best treatment options depend on multiple factors, including patient medical conditions and lesion characteristics.(1)Despite treatment options such as carotid endarterectomy, conventional carotid angioplasty/stent, and transcervical carotid revascularization, certain patients are not ideal candidates for any of these modalities. Novel technical advances such as intravascular lithotripsy (Shockwave Medical Inc.)have emerged as a potential treatment modality to treat patients with severely calcified plaques, a well-described limitation for carotid stent expansion and apposition.(2-4)The safety and efficacy of intravascular lithotripsy have been demonstrated through select case series and coronary artery disease I-II-III studies, culminating in its Food and Drug Administration approval for the management of novo, calcified, stenotic coronary arteries before stent placement.(2,5)This technical video presents an illustrative case of a patient with symptomatic severely calcified carotid plaque with previous neck radiation precluding endarterectomy, treated with off-label use of balloon lithotripsy plus stent.6The patient consented to the procedure.