Novel approach to treating calcified infrarenal aortic stenosis using intravascular lithotripsy without stenting

Abstract

This case report presents the use of intravascular lithotripsy (IVL) in a 68-year-old woman with disabling bilateral claudication owing to a heavily calcified subocclusive stenosis of the infrarenal aorta. The patient had a history of tobacco use, dyslipidemia, and chronic obstructive pulmonary disease, with absent femoral pulses and severe arterial calcification. A 12-mm Shockwave L6 lithotripsy catheter was employed to treat the aortic lesion, resulting in a significant decrease in the aortic pressure gradient without the need for stenting. The patient experienced complete symptom resolution postoperatively, and at 1 month, follow-up imaging confirmed vessel patency with no sign of restenosis. IVL, used here as a standalone treatment, demonstrated effectiveness in modifying calcified plaques and restoring vessel compliance, offering a less complex and potentially more cost-effective alternative to stent grafting in calcified aortic lesions. This case highlights the potential of IVL as a safe and effective treatment option in select patients with calcified infrarenal aortic stenosis.