# First Report of Intentional Intraplaque Lithotripsy After Aggressive Wire Recanalization in Calcified Atheroma and Dilatation (ARCADIA-SHOCK)

## TL;DR

This paper reports the first successful use of intentional intraplaque lithotripsy to treat calcified arteries in a patient with peripheral arterial disease.

## Contribution

The first reported case of intentional intraplaque lithotripsy as a new technique for treating eccentric calcified atheroma.

## Key findings

- Intraplaque lithotripsy was successfully used to treat heavily calcified superficial femoral arteries.
- The procedure was performed without complications in a claudicant patient.
- This technique may offer a safer alternative to atherectomy for eccentric calcium.

## Abstract

Eccentric calcified plaque remains a challenge in the endovascular treatment of peripheral arterial disease despite technological advancements. The "aggressive wire recanalization in calcified atheroma and dilatation" technique was invented to overcome this by intentional intraplaque wiring followed by atherectomy; however, distal embolization can ensue. Substitution with intravascular lithotripsy may be safer and equally effective. To the best of our knowledge, we performed the first case of intentional intraplaque lithotripsy to successfully treat a claudicant patient with heavily calcified bilateral superficial femoral arteries without complications. This may be considered a new technique variation to treat eccentric calcium.