Intravascular lithotripsy with peripheral Shockwave catheter – a breakthrough in calcified carotid artery stenosis treatment

Vascular calcium alters wall physical properties and consequently calcified vessels negatively affect stent expansion and apposition. Heavily calcified lesions may be difficult to dilate properly during an interventional procedure and thus are associated with a lower rate of technical success and a higher rate of complications. There are two main forms of calcification described in the peripheral vasculature: intimal (“coral reef”), which can protrude into the lumen, and medial (Mönckeberg’s sclerosis), which impairs wall compliance and elasticity [1]. It has been proved that calcium acts as a physical barrier to anti-proliferative drug penetration and distribution [2]. Appropriate deployment of the stent, good stent apposition and proper coverage of the target lesion sometimes seem to be extremely challenging due to calcium deposits. Our state-of-the-art instrumentarium incorporates new techniques to treat calcified lesions: specialty balloons (e.g. cutting, scoring, ultra-high-pressure), rotablation and atherectomy. We must remember that “debulking” devices may have a limited effect on deep calcium deposits [3]. This new concept of intravascular lithotripsy (IVL) was transferred from kidney stone treatment used for several decades. Intravascular lithotripsy uses high-speed pulsatile sonic pressure waves that pass through soft tissues and interact strongly with calcium. The technology gained the European CE Mark in May 2017 for coronary arteries. Then in June 2017 IVL gained the CE Mark and FDA approval for treatment of calcified lesions in lower limb atherosclerosis. Clinical data confirming safety and effectiveness of the IVL method can be found in the literature. One of the first published trials was the multicenter, prospective study Disrupt CAD, where the efficacy of lithoplasty in a group of 60 patients with severely calcified coronary artery lesions was investigated [4]. A subsequent study was Disrupt PAD II, which enrolled 60 subjects with complex, calcified peripheral stenosis treated with the IVL technique and followed for 12 months [5]. By contrast, we still lack studies enrolling patients with highly calcified plaques in carotid or innominate arteries. In the literature we can only find a few reports presenting single cases of carotid stenting assisted with intravascular lithotripsy. All cases reported were performed with coronary C2 4.0/12 mm catheters [6, 7]. We present the first-in-man use of a peripheral lithotripsy catheter...


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