Full text
2/2026
vol. 22
Short communication
Endovascular treatment strategies in highly-calcified carotid stenoses
Department of Vascular Surgery and Endovascular Interventions, St. John Paul II Hospital, Krakow, Poland
Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland
Department of Cardiac and Vascular Diseases, Jagiellonian University, Krakow, Poland
Stroke Thrombectomy-Capable Centre, St. John Paul II Hospital, Krakow, Poland
Department of Nursing, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
Cardiovascular Catheterization Laboratory, St. John Paul II Hospital, Krakow, Poland
Adv Interv Cardiol 2026; 22, 2 (84): 291–299
Data publikacji online: 2026/07/09
Article file
- Fu F, Liu X, Zhang R, et al. Prevalence and clinical implications of calcification in internal carotid artery stenosis: a retrospective study. BMC Neurol 2024; 24: 279.
- Musialek P, Bonati LH, Bulbulia R, et al. Stroke risk management in carotid atherosclerotic disease: a clinical consensus statement of the ESC Council on Stroke and the ESC Working Group on Aorta and Peripheral Vascular Diseases. Cardiovasc Res 2025; 121: 13-43.
- Wu WW, Liang P, O’Donnell TFX, et al. Anatomic eligibility for transcarotid artery revascularization and transfemoral carotid artery stenting. J Vasc Surg 2019; 69: 1452-60.
- Pini R, Faggioli G, Fittipaldi S, et al. Relationship between calcification and vulnerability of the carotid plaques. Ann Vasc Surg 2017; 44: 336-42.
- Kolodgie FD, Yahagi K, Mori H, et al. High-risk carotid plaque: lessons learned from histopathology. Semin Vasc Surg 2017; 30: 31-43.
- Katano H, Mase M, Nishikawa Y, et al. Calcified carotid plaques show double symptomatic peaks according to Agatston calcium score. J Stroke Cerebrovasc Dis 2015; 24: 1341-50.
- Kitamura K, Iwasaki K, Yano T, et al. Calcified cerebral emboli associated with calcified carotid plaque: a case report and morphological consideration for plaque calcification. Acta Neurochir 2024; 166: 439.
- Tekieli L, Afanasjev A, Mazgaj M, et al. A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE. Adv Interv Cardiol 2024; 20: 172-93.
- Tsutsumi M, Aikawa H, Onizuka M, et al. Carotid artery stenting for calcified lesions. Am J Neuroradiol 2008; 29: 1590-3.
- Tsutsumi M, Kodama T, Aikawa H, et al. Fragmentation of calcified plaque after carotid artery stenting in heavily calcified circumferential stenosis. Neuroradiology 2010; 52: 831-6.
- Roubin GS, Iyer S, Halkin A, et al. Realizing the potential of carotid artery stenting: proposed paradigms for patient selection and procedural technique. Circulation 2006; 113: 2021-30.
- Setacci C, Chisci E, Setacci F, et al. Siena carotid artery stenting score: a risk modelling study for individual patients. Stroke 2010; 41: 1259-65.
- Pelz DM, Lownie SP, Lee DH, et al. Plaque morphology (the PLAC Scale) on CT angiography: predicting long-term anatomical success of primary carotid stenting. J Neurosurg 2015; 123: 856-61.
- Fanous AA, Natarajan SK, Jowdy PK, et al. High-risk factors in symptomatic patients undergoing carotid artery stenting with distal protection: Buffalo Risk Assessment Scale (BRASS). Neurosurgery 2015; 77: 531-42.
- Kim CH, Kang J, Ryu WS, et al. Effects of carotid calcification on restenosis after carotid artery stenting: a follow-up study with computed tomography angiography. World Neurosurg 2018; 117: e514-21.
- Sun Y, Xu H, Kou L, et al. Calcification circumference, area, and location are associated with carotid stent expansion rate: high-resolution magnetic resonance vessel wall imaging study. Quant Imaging Med Surg 2023; 13: 4493-503.
- White CJ, Ramee SR, Collins TJ, et al. Carotid artery stenting: patient, lesion, and procedural characteristics that increase procedural complications. Catheter Cardiovasc Interv 2013; 82: 715-26.
- Macdonald S, Lee R, Williams R, at al.; Delphi Carotid Stenting Consensus Panel. Towards safer carotid artery stenting: a scoring system for anatomic suitability. Stroke 2009; 40: 1698-703.
- Kokkosis AA, Macdonald S, Jim J, et al. Assessing the suitability of the carotid bifurcation for stenting: anatomic and morphologic considerations. J Vasc Surg 2021 ;74: 2087-95.
- Reimers B, von Birgelen C, van der Giessen WJ, Serruys PW. A word of caution on optimizing stent deployment in calcified lesions: acute coronary rupture with cardiac tamponade. Am Heart J 1996; 131: 192-4.
- Katano H, Mase M, Nishikawa Y, et al. Surgical treatment for carotid stenoses with highly calcified plaques. J Stroke Cerebrovasc Dis 2014; 23: 148-54.
- Clark DJ, Lessio S, O’Donoghue M, et al. Mechanisms and predictors of carotid artery stent restenosis: a serial intravascular ultrasound study. J Am Coll Cardiol 2006; 47: 2390-6.
- Chang CK, Huded CP, Nolan BW, et al. Prevalence and clinical significance of stent fracture and deformation following carotid artery stenting. J Vasc Surg 2011; 54: 685-90.
- Mota L, Wang SX, Cronenwett JL, et al. Association of stroke or death with severity of carotid lesion calcification in patients undergoing carotid artery stenting. J Vasc Surg 2024; 79: 305-15.
- Rothenberg P, Lopez SJ, Thibault D, et al. Predictors of occlusion after carotid stenting. Ann Vasc Surg 2024; 102: 172-80.
- Barrett HE, Cunnane EM, Hidayat H, et al. Calcification volume reduces stretch capability and predisposes plaque to rupture in an in vitro model of carotid artery stenting. Eur J Vasc Endovasc Surg 2017; 54: 431-8.
- Bates ER, Babb JD, Casey DE Jr, et al. Clinical Expert Consensus Document Committee on Carotid Stenting. J Am Coll Cardiol 2007; 49: 126-70.
- Naylor R, Rantner B, Ancetti S, et al. European Society for Vascular Surgery (ESVS) 2023 Clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease. Eur J Vasc Endovasc Surg 2023; 65: 7-111.
- Rocha-Singh KJ, Zeller T, Jaff MR. Peripheral arterial calcification: prevalence, mechanism, detection, and clinical implications. Catheter Cardiovasc Interv 2014; 83: E212-20.
- Mazurek A, Partyka L, Trystula M, et al. Highly-calcific carotid lesions endovascular management in symptomatic and increased-stroke-risk asymptomatic patients using the CGuard™ dual-layer carotid stent system: analysis from the PARADIGM study. Catheter Cardiovasc Interv 2019; 94: 149-56.
- Wissgott C, Schmidt W, Brandt C, et al. Preliminary clinical results and mechanical behavior of a new double-layer carotid stent. J Endovasc Ther 2015; 22: 634-9.
- Wissgott C, Schmidt W, Brandt-Wunderlich C, et al. Clinical results and mechanical properties of the carotid CGUARD double-layered embolic prevention stent. J Endovasc Ther 2017; 24: 130-7.
- Musialek P. Proximal embolic protection with the Mo.Ma device: a “must know how” for competent carotid artery stenting. Endovascular Today 2024; 23: 30-3.
- Stabile E, de Donato G, Musialek P, et al. Use of dual-layered stents for carotid artery angioplasty: 1-year results of a patient-based meta-analysis. JACC Cardiovasc Interv 2020; 13: 1709-15.
- Langhoff R, Vajda Z, Odrowąż-Pieniążek P, et al. 30-day outcomes of real-world elective carotid stenosis treatment using a dual-layer micromesh stent (ROADSAVER Study). Cardiovasc Intervent Radiol 2025; 48: 427-37.
- Janus B, Dziadek W, Kowalewska-Kempa J, et al. MicroNET-covered stent ‘sandwich’ technique to seal carotid artery perforation in a highly-calcific lesion. Adv Interv Cardiol 2024; 20: 494-9.
- CONFIDENCE Trial - Carotid Stent Trial to Evaluate the Safety and Efficacy of the Roadsaver™ Stent Used in Conjunction with the Nanoparasol Embolic Protection System for Patients at Increased Risk for Adverse Events from Carotid Endarterectomy. https://wwwaccessdatafdagov/cdrh_docs/pdf21/P210030Bpdf (accessed 05.06.2026).
- Musialek P, Tekieli L, Umemoto T. Carotid antiembolic (“Mesh”) stents: not created equal. J Soc Cardiovasc Angiogr Interv 2024; 3: 102429.
- Balocco S, Rigla J, Andresen R, et al. One-size-fits-all strategy in carotid artery treatment using CGuard stent, feasibility and clinical pilot study. CVIR Endovasc 2025; 8: 86.
- Choudhury A, Protty MB, Hussain H, et al. Calcium challenge – tackling rings, nodules and plates: how can we get more from intravascular lithotripsy technology? Interv Cardiol 2025; 20: e30.
- Wada T, Takayama K, Myouchin K, et al. Predicting in-stent restenosis following carotid artery stenting using a dual metallic layer braided micromesh stent. 2026 (at review). Presented at the 2026 ICCA/Stroke Conference (https://iccaonline.org/archive/takayama accessed 11.06.2026).
- Romaguera R, Gomez-Hospital JA, Cequier A. Novel use of the MGuard mesh-covered stent to treat coronary arterial perforations. Catheter Cardiovasc Interv 2012; 80: 75-8.
- Lehmann MF, Musialek P. MicroNET-covered stent use to seal carotid artery perforation. Adv Interv Cardiol 2023; 19: 284-8.
- Mazurek A, Malinowski K, Sirignano P, et al. (CArotid Revascularization systematic reviews and MEta-aNalyses (CARMEN) Collaborators). Carotid artery revascularization using second generation stents versus surgery: a meta-analysis of clinical outcomes. J Cardiovasc Surg 2023; 64: 570-82.
- Imahori T, Miyake S, Maeda I, et al. Carotid artery stenting for heavily calcified lesions after plaque modification using scoring balloon angioplasty. Interv Neuroradiol 2025 doi: 10.1177/15910199251336945.
- Musialek P, de Donato G. Carotid artery revascularization using the endovascular route. In: Peripheral Arterial interventions: A Practical Guide. Ruzsa Z, Bartus S, Nemes B (eds.). Edizioni Minerva Medica, Torino 2023; 142-72.
- Cremonesi A, Roffi M, Castriota F, et al. Carotid artery stenting. In: The 2025 PCR Textbook of Percutaneous Interventional Cardiovascular Medicine. Windecker S, Byrne R, Capranzano P, eds. PCRonline.com https://textbooks.pcronline.com/the-pcr-textbook/carotid-artery-stenting (accessed 05.06.2026).
- Kereiakes DJ, Virmani R, Hokama JY, et al. Principles of intravascular lithotripsy for calcific plaque modification. JACC Cardiovasc Interv 2021; 14: 1275-92.
- Shockwave IVL overview and products portfolio. https://shockwavemedical.com/ivl-overview/
- Misztal M, Trystula M, Konieczynska M, et al. Intravascular lithotripsy with peripheral Shockwave catheter – a breakthrough in calcified carotid artery stenosis treatment. Adv Interv Cardiol 2020; 16: 491-4.
- Vadalà G, Galassi AR, Nerla R, et al. Shockwave intravascular lithoplasty for the treatment of calcified carotid artery stenosis: a very early single-center experience. Catheter Cardiovasc Interv 2020; 96: E608-13.
- Khalid N, Case BC, Ahmad SA, et al. Intravascular lithotripsy-facilitated carotid interventions. J Endovasc Ther 2021; 28: 486.
- DiLosa K, Schonefeld S, El-Khoury R, et al. Multi-center experience with intravascular lithotripsy for treatment of severe calcification during transcarotid artery revascularization for high-risk patients. J Vasc Surg 2024; 80: 757-63.
- Hernandez Langarica DA, Gonzalez-Salido J, Hernandez AJ, et al. Intravascular lithotripsy in calcified carotid stenosis: technical and clinical outcomes. J Neurointerv Surg 2026; 18: 1347-54.
- Musialek P, Mazurek A, Trystula M, et al. Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard MicroNet-covered embolic prevention stent system. EuroIntervention 2016; 12: e658-70.
- Musialek P, Hopkins LN, Siddiqui AH. One swallow does not a summer make but many swallows do: accumulating clinical evidence for nearly-eliminated peri-procedural and 30-day complications with mesh-covered stents transforms the carotid revascularisation field. Adv Interv Cardiol 2017; 13: 95-106.
- Karpenko A, Bugurov S, Ignatenko P, et al. Randomized controlled trial of conventional versus MicroNet-covered stent in carotid artery revascularization. JACC Cardiovasc Interv 2021; 14: 2377-87.
- Schofer J, Musiałek P, Bijuklic K, et al. A Prospective, multicenter study of a novel mesh-covered carotid stent: the CGuard CARENET Trial (Carotid Embolic Protection Using MicroNet). JACC Cardiovasc Interv 2015; 8: 1229-34.
- Metzger DC, Soukas P, Siddiqui A, et al.; C-GUARDIANS Investigators. Safety and efficacy of a novel Micro Net Carotid Stent System: results of the C-GUARDIANS trial. JACC Cardiovasc Interv 2025; 18: 3087-97.
- Musialek P, Grunwald IQ, Siddiqui AH. ESC consensus statement on stroke risk management in carotid atherosclerotic disease: 10 key points. Eur Heart J 2025; 46: 4150-3.
- Musialek P, Malinowski K, Tekieli L, et al. CREST-2 findings are unchanged using an aggregated control group for the CAS and CEA trial. Adv Interv Cardiol 2026; 22: 178-89.
Copyright: © 2026 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.