Adjunctive intravascular lithotripsy for heavily calcified carotid stenosis: a dual-center experience and technical case series.

IF 4.5 1区 医学 Q1 NEUROIMAGING Journal of NeuroInterventional Surgery Pub Date : 2024-11-07 DOI:10.1136/jnis-2024-022545
Ricardo A Hanel, Vinay Jaikumar, Salvador F Gutierrez-Aguirre, Hamid Sharif Khan, Otavio F De Toledo, Jaims Lim, Tyler A Scullen, Fernanda Rodriguez-Erazú, Bernard Okai, Matthew J McPheeters, Mehdi Bouslama, Kunal P Raygor, Adnan H Siddiqui
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Abstract

Background: Heavily calcified carotid stenosis (HCCS) is considered an exclusion for carotid angioplasty and/or stenting (CAS), amenable only to carotid endarterectomy. This study presents preliminary retrospective dual-center experience utilizing the Shockwave S4 intravascular lithotripsy (IVL) system (Shockwave Medical) as an adjunct to CAS for HCCS.

Methods: Patients with symptomatic or asymptomatic HCCS (de novo stenosis or in-stent restenosis (ISR)) undergoing IVL+CAS were included. Charts were reviewed for demographic, imaging, procedural, and outcome data. The primary endpoint was composite major adverse event (MAE) rate: death, ipsilateral stroke, or myocardial infarction (MI) within 30 days of IVL+CAS. Secondary endpoints included technical and procedural success, residual stenosis, and ISR postprocedure.

Results: Fifteen patients underwent 17 IVL+CAS procedures: de novo HCCS=13, heavily calcified ISR=4; symptomatic disease was addressed in seven cases. Procedures were performed transfemorally under conscious sedation with dual protection; flow reversal through a balloon guide catheter, and distal embolic protection system (EPS) use. Median pre-IVL+CAS stenosis was 73% (IQR 60-80%). Technical success (IVL+CAS+ EPS use) was achieved in all cases. Median post-IVL+CAS residual stenosis was 27% (IQR 12-33%), achieving <50% residual stenosis and procedural success in all. Five patients required dopamine infusion for postprocedural hypotension. No periprocedural ipsilateral strokes occurred. MAE rate was 6.7% (95% CI 0.2% to 32%), including one MI resulting in death. Additionally, one ISR (6.3%; 95% CI 0.2% to 30.2%) identified 160 days after IVL+CAS was retreated with angioplasty.

Conclusions: IVL+CAS 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.

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重度钙化颈动脉狭窄的辅助血管内碎石术:双中心经验和技术病例系列。
背景:严重钙化的颈动脉狭窄(HCCS)被认为是颈动脉血管成形术和/或支架植入术(CAS)的禁忌症,只能进行颈动脉内膜剥脱术。本研究介绍了利用冲击波 S4 血管内碎石(IVL)系统(Shockwave Medical)辅助 CAS 治疗 HCCS 的初步回顾性双中心经验:方法:纳入接受IVL+CAS治疗的无症状或无症状HCCS患者(新生血管狭窄或支架内再狭窄(ISR))。对病历中的人口统计学、影像学、程序和结果数据进行审查。主要终点是复合主要不良事件(MAE)发生率:IVL+CAS 30 天内死亡、同侧中风或心肌梗死(MI)。次要终点包括技术和手术成功率、残余狭窄和术后ISR:15名患者接受了17例IVL+CAS手术:新发HCCS=13例,重度钙化ISR=4例;7例患者接受了无症状疾病治疗。手术在有意识镇静和双重保护下经血道进行;通过球囊导引导管进行血流逆转,并使用远端栓塞保护系统(EPS)。IVL+CAS前的中位狭窄率为73%(IQR 60-80%)。所有病例都取得了技术成功(IVL+CAS+使用EPS)。IVL+CAS术后残余狭窄中位数为27%(IQR 12-33%):IVL+CAS治疗无症状和无症状HCCS安全有效,MAE发生率高。IVL有可能扩大CAS在难以治疗的HCCS中的作用。
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来源期刊
CiteScore
9.50
自引率
14.60%
发文量
291
审稿时长
4-8 weeks
期刊介绍: The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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