Postępy w Kardiologii Interwencyjnej

Full text

3/2026 vol. 22
Short communication

Intravascular lithotripsy for highly calcified carotid stenoses: distal (filter) protection may not suffice

  1. Department of Cardiac and Vascular Diseases, Jagiellonian University, Krakow, Poland

  2. Cardiovascular Catheterization Laboratory, St. John Paul II Hospital, Krakow, Poland

  3. Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland

  4. Department of Neurology with Stroke Unit, St. John Paul II Hospital, Krakow, Poland

  5. Department of Grown-Up Congenital Heart Disease, St. John Paul II Hospital, Krakow, Poland

  6. Department of Radiology and Imaging Diagnostics, St. John Paul II Hospital, Krakow, Poland

  7. AGH University of Science and Technology, Krakow, Poland

Adv Interv Cardiol 2026; 22, 3 (85): 517–523

Data publikacji online: 2026/09/30
Article file
Intravascular lithotripsy.pdf
  1. 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.
  2. Bates ER, Babb JD, Casey DE Jr, et al. ACCF/SCAI/SVMB/SIR/ASITN 2007 clinical expert consensus document on carotid stenting: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). J Am Coll Cardiol 2007; 49: 126-70.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Paluszek P, Tekieli L, Mazurek A, et al. Endovascular treatment strategies in highly-calcified carotid stenoses. Adv Interv Cardiol 2026; 22: 291-9.
  8. 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.
  9. Kereiakes DJ, Virmani R, Hokama JY, et al. Principles of intravascular lithotripsy for calcific plaque modification. JACC Cardiovasc Interv 2021; 14: 1275-92.
  10. 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.
  11. Tepe G, Brodmann M, Werner M, et al. Intravascular lithotripsy for peripheral artery calcification: 30-day outcomes from the randomized disrupt PAD III Trial. JACC Cardiovasc Interv 2021; 14: 1352-61.
  12. Brodmann M, Holden A, Zeller T. Safety and feasibility of intravascular lithotripsy for treatment of below-the-knee arterial stenoses. J Endovasc Ther 2018; 25: 499-503.
  13. Grillo P, Tripolino C, Tassone EJ, et al. Critical calcified carotid stenosis treated with shockwave lithoplasty. Arch Med Sci Atheroscler Dis 2018; 3: e164-5.
  14. 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.
  15. 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.
  16. 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.
  17. Elsayed N, Yei KS, Naazie I, et al. The impact of carotid lesion calcification on outcomes of carotid artery stenting. J Vasc Surg 2022; 75: 921-9.
  18. Yadav JS, Wholey MH, Kuntz RE, et al. (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators). Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004; 351: 1493-501.
  19. 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.
  20. Musialek P, Pieniazek P, Tracz W, et al. Safety of embolic protection device-assisted and unprotected intravascular ultrasound in evaluating carotid artery atherosclerotic lesions. Med Sci Monit 2012; 18: MT7-18.
  21. Mauriello A, Sangiorgi GM, Virmani R, et al. A pathobiologic link between risk factors profile and morphological markers of carotid instability. Atherosclerosis 2010; 208: 572-80.
  22. Pini R, Faggioli G, Fittipaldi S, et al. Relationship between calcification and vulnerability of the carotid plaques. Ann Vasc Surg 2017; 44: 336-42.
  23. Kolodgie FD, Yahagi K, Mori H, et al. High-risk carotid plaque: lessons learned from histopathology. Semin Vasc Surg 2017; 30: 31-43.
  24. 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.
  25. 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.
  26. Bijuklic K, Wandler A, Hazizi F, Schofer J. The PROFI study (Prevention of Cerebral Embolization by Proximal Balloon Occlusion Compared to Filter Protection During Carotid Artery Stenting): a prospective randomized trial. J Am Coll Cardiol 2012; 59: 1383-9.
  27. 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.
  28. Case BC, Yerasi C, Forrestal BJ, et al. Intravascular lithotripsy facilitated percutaneous endovascular intervention of the aortic arch: a single-center experience. Cardiovasc Revasc Med 2020; 21: 1006-15.
  29. Mitchell M, Verhey LH, Taylor N, et al. Intravascular lithotripsy followed by angioplasty and stenting for severely calcified carotid artery stenosis: technical note and case series. Front Neurol 2025; 16: 1634201.
  30. 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.
  31. 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.
  32. Traenka C, Engelter ST, Brown MM, et al. Silent brain infarcts on diffusion-weighted imaging after carotid revascularisation: a surrogate outcome measure for procedural stroke? A systematic review and meta-analysis. Eur Stroke J 2019; 4: 127-43.
  33. Lansky AJ, Grubman D, Dwyer MG 3rd, et al. Clinical significance of diffusion-weighted brain MRI lesions after TAVR: results of a patient-level pooled analysis. J Am Coll Cardiol 2024; 84: 712-22.
  34. Giannopoulos S, Speziale F, Vadalà G, et al. Intravascular lithotripsy for treatment of calcified lesions during carotid artery stenting. J Endovasc Ther 2021; 28: 93-9.
  35. Chmiel J, Tekieli L, Mazurek A, et al. Filter protection in contemporary carotid artery stenting: consider limited protection. Adv Interv Cardiol 2024; 20: 213-6.
  36. Tulip HH, Rosero EB, Higuera AJ, et al. Cerebral embolization in asymptomatic versus symptomatic patients after carotid stenting. J Vasc Surg 2012; 56: 1579-84.
  37. Sangiorgi G, Bedogni F, Sganzerla P, et al. The Virtual histology In CaroTids Observational RegistrY (VICTORY) study: a European prospective registry to assess the feasibility and safety of intravascular ultrasound and virtual histology during carotid interventions. Int J Cardiol 2013; 168: 2089-93.
  38. Timaran CH, Rosero EB, Martinez AE, et al. Atherosclerotic plaque composition assessed by virtual histology intravascular ultrasound and cerebral embolization after carotid stenting. J Vasc Surg 2010; 52: 1188-94.
  39. Zhu G, Hom J, Li Y, et al. Carotid plaque imaging and the risk of atherosclerotic cardiovascular disease. Cardiovasc Diagn Ther 2020; 10: 1048-67.
  40. Sabat J, Bock D, Hsu CH, et al. Risk factors associated with microembolization after carotid intervention. J Vasc Surg 2020; 71: 1572-8.
  41. Sakurada K, Yamada K, Amemiya K, et al. Difficulties in carotid artery stenting due to calcified nodules: a case report. Cureus 2023; 15: e46233.
  42. 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.
  43. 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.
  44. Ansel GM, Hopkins LN, Jaff MR, et al. Safety and effectiveness of the INVATEC MO.MA proximal cerebral protection device during carotid artery stenting: results from the ARMOUR pivotal trial. Catheter Cardiovasc Interv 2010; 76: 1-8.
  45. Nikas D, Reith W, Schmidt A, et al. Prospective, multicenter European study of the GORE flow reversal system for providing neuroprotection during carotid artery stenting. Catheter Cardiovasc Interv 2012; 80: 1060-8.
  46. Stabile E, Sannino A, Schiattarella GG, et al. Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion. JACC Cardiovasc Interv 2014; 7: 1177-83.
  47. White CJ. Proximal embolic protection: a “game changer” for carotid stents. J Am Coll Cardiol 2010; 55: 1668-70.
  48. Karpenko A, Castrucci T, Partyka L, et al. Cerebral embolism in transfemoral carotid artery stenting using proximal protection and micronet-covered stents: PROXGUARD Study. JACC Cardiovasc Interv 2026 (in press).
  49. Karpenko A, Bugurov S, Ignatenko P, et al. Randomized controlled trial of conventional versus micronet-covered stent in carotid artery revascularization: 12-month outcomes. JACC Cardiovasc Interv 2023; 16: 878-80.
  50. Musialek P, Langhoff R, Stefanini M, et al. Carotid stent as cerebral protector: the arrival of Godot. J Cardiovasc Surg 2023; 64: 555-60.
  51. Mazurek A, Malinowski K, Rosenfield K, et al.; CARMEN (CArotid Revascularization Systematic Reviews and MEta-aNalyses) Investigators. Clinical outcomes of second- versus first-generation carotid stents: a systematic review and meta-analysis. J Clin Med 2022; 11: 4819.
  52. 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.
  53. Musialek P, Roubin GS. Double-layer carotid stents: from the clinical need, through a stent-in-stent strategy, to effective plaque isolation… the Journey Toward Safe Carotid Revascularization Using the Endovascular Route. J Endovasc Ther 2019; 26: 572-7.
  54. Mazurek A, Borratynska A, Malinowski KP, et al. MicroNET-covered stents for embolic prevention in patients undergoing carotid revascularisation: twelve-month outcomes from the PARADIGM study. EuroIntervention 2020; 16: e950-2.
  55. 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.
  56. Lehmann MF, Musialek P. MicroNET-covered stent use to seal carotid artery perforation. Adv Interv Cardiol 2023; 19: 284-8.
  57. 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.
  58. Musialek P, Tekieli L, Umemoto T. Carotid antiembolic (“Mesh”) stents: not created equal. J Soc Cardiovasc Angiogr Interv 2024; 3: 102429.
  59. 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.
  60. 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.
  61. Abbott JD, Amoroso N, Aronow H, et al. Clinical conference proceedings: International Andreas Gruentzig Society 2026 summary document. J Invasive Cardiol 2026; 38: 8.
  62. Sakamoto S, Kiura Y, Okazaki T, et al. Usefulness of dual protection combined with blood aspiration for distal embolic protection during carotid artery stenting. Acta Neurochir 2015; 157: 371-7.
  63. Kajihara Y, Sakamoto S, Kiura Y, et al. Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience. Neurosurg Rev 2015; 38: 671-6.
  64. Vuruskan E, Saracoglu E, Ergun U, et al. Carotid artery stenting with double cerebral embolic protection in asymptomatic patients – a diffusion-weighted MRI controlled study. Vasa 2017; 46: 29-35.
  65. Parodi JC, Schönholz C, Ferreira LM, et al. “Seat belt and air bag” technique for cerebral protection during carotid stenting. J Endovasc Ther 2002; 9: 20-4.
  66. Musialek P, Grunwald IQ, Siddiqui AH. ESC consensus statement on stroke risk management in carotid atherosclerotic disease: 10 key points. Eur Heart J 2025; 4: 4150-3.
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.
Share
without publication fees