Successful Use of Adjunctive Orbital Atherectomy for Extensively Calcified Carotid Artery Lesions Using Flow Reversal Neuroprotection Technique

The use of transcarotid artery revascularization (TCAR) technique for carotid atherosclerotic disease has become increasingly popular as the endovascular alternative to traditional carotid endarterectomy. TCAR does offer a minimally invasive approach to carotid lesions, however, several technical and anatomic considerations, such as extensive calcification, limit its widespread applicability. Both orbital and rotational atherectomy are commonly used for extensively calcified lesions in the peripheral vasculature with satisfactory results for luminal gain. Herein, we describe the use of orbital atherectomy of a severely calcified ostial carotid lesion using reverse flow technique for neuroprotection during TCAR in a patient considered high risk for carotid endarterectomy.