Intravascular iliac artery lithotripsy to enable transfemoral thoracic endovascular aortic repair

Abstract

Thoracic endovascular aortic repair (TEVAR) is performed with large‐bore delivery systems. Small‐size access vessels may be a contraindication for TEVAR, particularly in case of severe calcifications. In this case report, we describe the first‐in‐man use of intravascular lithotripsy to enable transfemoral delivery of TEVAR stent grafts in a patient with severely calcified iliac arteries. A 69‐year‐old female with multiple sclerosis and thoracic aortic aneurysm (TAA) was referred for percutaneous TEVAR. Both common iliac arteries were severely calcified with circumferential calcifications and a minimum diameter below 5.5 mm. In order to enable percutaneous delivery of 20 French Valiant Navion stent grafts (Medtronic), the circumferential calcified plaques were treated by use of a Shockwave™ Peripheral Intravascular Lithotripsy Balloon (Shockwave Medical Inc.). Subsequently, the aortic stent grafts were safely and successfully passed through the iliofemoral artery and the TAA was excluded by TEVAR. Final angiography showed normal flow in the iliofemoral artery without any signs of perforation or overt dissection. This case report demonstrates successful application of intravascular lithotripsy in calcified iliofemoral arteries enabling percutaneous transfemoral TEVAR. If confirmed in future cases and trials, indications for transfemoral TEVAR may further expand toward patients with severely calcified peripheral arterial disease.

Use of intravascular lithotripsy in non-coronary artery lesions

“…IVL was used to improve vessel compliance and predilection before stent placement[ 16 ]. Several authors reported the use of IVL for severely calcified vessels before stent placement[ 16 , 19 ] or before treatment with drug-coated balloon angioplasty[ 20 ]. IVL was also used in severely calcified vessels as a stand-alone treatment without stent placement.…”

Emergency Intravascular Aortic and Iliac Artery Lithotripsy to Facilitate Thoracic Endovascular Aortic Repair of a Ruptured Thoracic Aortic Aneurysm: A Case Report

“…3 Intravascular lithotripsy (IVL) has emerged as a safe and effective option in the treatment of severely calcified vessels. [4][5][6][7] The principal mechanism of lithotripsy has been used in medicine for over 30 years in the treatment of nephrolithiasis, cholelithiasis, and joint calcifications.…”

Can Most Calcified Coronary Stenosis Be Optimized With Coronary Intravascular Lithotripsy?

“…Disrupt CAD III will have a 2-year follow-up period and will provide long-term clinical outcome data to assess the efficacy of improved stent insertion after intracoronary IVL use. This study included patients with unstable coronary syndromes, ostial or bifurcation coronary lesions, treatment of in-stent restenosis or underexpanded coronary stents, 22 , 23 , 24 , 25 extreme calcification in upper extremity vessels (ie, carotid, subclavian/axillary, innominate) and vein grafts, as well as the infrarenal aorta, radial, and brachial arteries. After obtaining U.S. Food and Drug Administration approval of the Shockwave Coronary IVL System, an investigator-sponsored all-comers registry is currently enrolling in Spain (REPLICA [Registry of Coronary Lithotripsy in Spain; NCT04298307 ]; n = 400), and postmarket consent research is being evolved to use the American College of Cardiology National Cardiovascular Data Registry CathPCI Registry to provide perspectives into device safety and effectiveness in an expanded real-world setting.…”