Intravascular lithotripsy for severe calcific internal carotid artery disease during transcarotid revascularization

Heavy internal carotid artery (ICA) calcification is considered a relative contra-indication to transcarotid artery revascularization (TCAR). Meanwhile, intravascular lithotripsy (IVL) is increasingly utilized for vessel preparation prior to stent placement in peripheral and coronary artery disease. Here, we report four patients who underwent IVL for bulky calcific ICA stenosis followed by stent placement using the TCAR system with excellent luminal gain. Intravascular ultrasound is a feasible adjunct and can be efficiently employed to rule out significant residual stenosis.