The use of intravascular lithotripsy in conjunction with transcarotid artery revascularization for high grade carotid artery stenosis

Abstract Transcarotid artery revascularization (TCAR) with dynamic flow reversal has been shown to be safe and effective in preventing stroke during carotid artery stenting (CAS), and has offered a less invasive option for carotid revascularization. Heavily calcified lesions has been a relative contraindication for carotid stenting in the past, although the use of intravascular lithotripsy (IVL)- a process of sonic pressure that fractures the calcium deposits has been shown to be effective in treating calcified lesions in arteries. When compared to carotid endarterectomy, TCAR has been shown to have similar complication rates for stroke and mortality and fewer complications when compared to transfemoral carotid artery stenting Herein, we describe a case of utilizing IVL to treat highly calcified carotid lesions before TCAR for a patient who otherwise would be a high-risk surgical patient.