Pre-stenting lesion preparation using shockwave intravascular lithotripsy in severely calcified superior mesenteric artery stenosis

TL;DR

A new technique using shockwave intravascular lithotripsy (IVL) was successfully used to prepare a severely calcified artery before stent placement in a patient's superior mesenteric artery.

Contribution

This case demonstrates the first reported use of IVL for lesion preparation in a severely calcified superior mesenteric artery stenosis.

Findings

IVL effectively prepared the calcified lesion for stent deployment with low residual stenosis.

The procedure was performed without complications and enabled full stent expansion.

IVL may offer a less traumatic alternative to traditional methods for treating calcified visceral arteries.

Abstract

Intravascular lithotripsy (IVL) is an emerging technique for modifying heavily calcified arterial lesions, with primary application in peripheral arteries. We report the use of IVL for lesion preparation prior to stenting in a patient with severely calcified superior mesenteric artery (SMA) stenosis.

A 66-year-old man with type I adenocarcinoma of the esophagogastric junction (AEG Type I) and neoadjuvant FLOT chemotherapy was scheduled for Ivor Lewis esophagectomy. Preoperative CT angiography (CTA) revealed a high-grade ostial SMA stenosis due to extensive atherosclerotic calcification. To mitigate the risk of postoperative mesenteric hypoperfusion, percutaneous endovascular revascularization was performed. Following initial predilatation, IVL using a Shockwave 5.5 × 60 mm balloon catheter was employed for lesion preparation. Subsequently, an 8.0 × 24 mm balloon-expandable stent was successfully deployed with low-grade residual stenosis and no complications.

This case demonstrates that IVL represents a feasible and effective adjunct in the management of severely calcified visceral arterial lesions. It facilitates adequate lesion preparation and enables full stent expansion, even when the IVL balloon diameter is notably smaller than the stent diameter. This potentially represents a less traumatic approach to the vessel than alternative techniques. IVL may therefore be considered a therapeutic option in selected patients.

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