Carotid artery stenting with intravascular lithotripsy for calcific carotid stenosis: A systematic literature review

Abstract

Background Endovascular techniques such as stenting, endarterectomy, and transcarotid arterial revascularization are common therapeutic options in the management of carotid artery stenosis; however, they involve a risk of major complications (e.g. in-hospital transient ischemic attack or ischemic stroke). The application of shock wave therapy in the form of intravascular lithotripsy has been increasingly explored among patients with calcified arterial lesions. To the best of our knowledge, the diverse applications of intravascular lithotripsy have been documented in the context of peripheral artery disease, coronary artery disease, and transcarotid arterial revascularization; however, limited research has been conducted on other domains of endovascular management. In this systematic review, we aimed to elucidate the complication profile and document the safety of off-label intravascular lithotripsy prior to carotid artery stenting for calcific carotid artery stenosis. Methods A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, in which the databases of PubMed, CINAHL, Embase, and Scopus were searched to identify all cases of reported carotid artery stenosis treated with intravascular lithotripsy in conjunction with carotid artery stenting. Results Of the 711 initially identified articles, 7 were selected because they met the study criteria. Finally, 11 patients aged 56–82 years were included in our review. The prevalence of preoperative stenosis ranged from 60% to 95%; postoperative vessel patency was described in all cases. In the postoperative period, one patient experienced transient right eye blindness secondary to central retinal artery occlusion and another patient sustained a left hemispheric transient ischemic attack. Conclusion We explored the application of intravascular lithotripsy in carotid artery stenting procedures, in which success in improving lumen patency has been documented. Although postoperative complications such as transient ischemic attack have been reported, all patients exhibited good clinical outcomes, with no new permanent deficits being observed. Our findings cautiously recommend the use of intravascular lithotripsy as an adjunct to carotid artery stenting in the management of calcific carotid stenosis as a safe therapeutic option in selected patients. However, further research on this subject is warranted.