Shockwave Lithotripsy for Severe Calcified Extracranial Vertebral and Carotid Disease Treated With Percutaneous Stenting
- 1Wellstar Medical Group, Department of Neurosurgery, Wellstar Health System Kennestone Hospital, Marietta, GA (J.C.M.G., A.K., W.H., S.D., B.Z., R.G.).
- 2Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY (A.C.G.).
Abstract
Background
Patients harboring heavily calcified concentric or eccentric type lesions in the carotid or vertebral artery pose a challenge in placing a stent to reduce the lesion. These lesions yield suboptimal results due to poor stent expansion. Shockwave lithotripsy offers a potential solution for achieving luminal gain.Methods
We present a retrospective study of all patients at our institution who were treated with lithotripsy for extracranial carotid or vertebral artery stenosis associated with heavily calcified lesions from July 2022 to February 2026. Data were maintained in our procedural database and retrospectively analyzed for patients treated with lithotripsy. All consecutive patients were analyzed for demographic information, procedural data, perioperative complications, and 6-month midterm follow-up imaging for restenosis.Results
A total of 41 patients (8 vertebral artery lesions and 33 carotid lesions) were treated with intravascular lithotripsy at our institution between July 2022 and February 2026. The mean age for the cohort was 70.7 ± 8.7. The mean lesion pretreatment for the carotid stenosis was 77 ± 13% and for the vertebral artery treated patients 81 ± 11%. All patients were successfully treated with stenting and lithotripsy, and the mean stenosis posttreatment was 15 ± 14% for the carotid stenosis and 8 ± 5% for the vertebral artery lesions. There were 2 groin complications (5%) with femoral artery pseudoaneurysms treated with thrombin injection and 1 perioperative stroke (3%) secondary to a dissection in the carotid stent cohort.Conclusions
The current study demonstrates the feasibility of lithotripsy for heavily calcified lesions treated with transfemoral stenting. Future prospective core laboratory adjudicated studies are warranted to determine the efficacy of this technique.
Related
- Treatment of Calcified Peripheral Artery Disease With the Shockwave Forward Peripheral Intravascular Lithotripsy System: One-Year Outcomes From the FORWARD PAD IDE and Mini S Feasibility Studies
- Stent-less percutaneous coronary intervention for a severely calcified coronary lesion using combined orbital atherectomy and intravascular lithotripsy followed by drug-coated balloon: case report
- Intravascular lithotripsy for highly calcified carotid stenoses: distal (filter) protection may not suffice
- Optical Coherence Tomography Findings Following Intravascular Lithotripsy in Calcified Coronary Artery Disease: A Systematic Review and Meta-Analysis
- Lipid-Rich Plaque Beneath Dense Calcium: Imaging-Guided Lithotripsy in Calcified Double-Vessel Disease.
BibTeX
@article{gutierrez2026shockwave,
title = {{Shockwave Lithotripsy for Severe Calcified Extracranial Vertebral and Carotid Disease Treated With Percutaneous Stenting}},
author = {Juan Carlos Martinez Gutierrez and Akash C Gupta and Ahmad Khaldi and William Humphries and Salvatore D'Amato and Benjamin Zussman and Rishi Gupta},
journal = {Stroke (Hoboken, N.J.)},
year = {2026},
month = nov,
doi = {10.1161/svin.126.002495},
url = {https://europepmc.org/article/PMC/PMC13727253},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Shockwave Lithotripsy for Severe Calcified Extracranial Vertebral and Carotid Disease Treated With Percutaneous Stenting
AU - Juan Carlos Martinez Gutierrez
AU - Akash C Gupta
AU - Ahmad Khaldi
AU - William Humphries
AU - Salvatore D'Amato
AU - Benjamin Zussman
AU - Rishi Gupta
PY - 2026
DA - 2026/11/01
JO - Stroke (Hoboken, N.J.)
DO - 10.1161/svin.126.002495
UR - https://europepmc.org/article/PMC/PMC13727253
AB - Background Patients harboring heavily calcified concentric or eccentric type lesions in the carotid or vertebral artery pose a challenge in placing a stent to reduce the lesion. These lesions yield suboptimal results due to poor stent expansion. Shockwave lithotripsy offers a potential solution for achieving luminal gain.Methods We present a retrospective study of all patients at our institution who were treated with lithotripsy for extracranial carotid or vertebral artery stenosis associated with heavily calcified lesions from July 2022 to February 2026. Data were maintained in our procedural database and retrospectively analyzed for patients treated with lithotripsy. All consecutive patients were analyzed for demographic information, procedural data, perioperative complications, and 6-month midterm follow-up imaging for restenosis.Results A total of 41 patients (8 vertebral artery lesions and 33 carotid lesions) were treated with intravascular lithotripsy at our institution between July 2022 and February 2026. The mean age for the cohort was 70.7 ± 8.7. The mean lesion pretreatment for the carotid stenosis was 77 ± 13% and for the vertebral artery treated patients 81 ± 11%. All patients were successfully treated with stenting and lithotripsy, and the mean stenosis posttreatment was 15 ± 14% for the carotid stenosis and 8 ± 5% for the vertebral artery lesions. There were 2 groin complications (5%) with femoral artery pseudoaneurysms treated with thrombin injection and 1 perioperative stroke (3%) secondary to a dissection in the carotid stent cohort.Conclusions The current study demonstrates the feasibility of lithotripsy for heavily calcified lesions treated with transfemoral stenting. Future prospective core laboratory adjudicated studies are warranted to determine the efficacy of this technique.
SN - 2694-5746
ER -