Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report

Severe vertebral artery stenosis complicated by dense calcification represents a significant surgical challenge, particularly when accompanied by limited collateral circulation. Traditional high-pressure balloon angioplasty is an adequate option. However, it can increase the risk of vascular injury...

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Main Authors: Orlando Diaz, MD, Jochen Gerstner-Saucedo, MD, Isabel Carmona
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Radiology Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S1930043325005680
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author Orlando Diaz, MD
Jochen Gerstner-Saucedo, MD
Isabel Carmona
author_facet Orlando Diaz, MD
Jochen Gerstner-Saucedo, MD
Isabel Carmona
author_sort Orlando Diaz, MD
collection DOAJ
description Severe vertebral artery stenosis complicated by dense calcification represents a significant surgical challenge, particularly when accompanied by limited collateral circulation. Traditional high-pressure balloon angioplasty is an adequate option. However, it can increase the risk of vascular injury and it often achieves inadequate stent expansion. Intravascular lithotripsy (IVL) has recently been proposed as an alternative method for safely fracturing calcified plaques with acoustic pressure waves at lower balloon pressures. We report a symptomatic patient where IVL was used for predilation during a vertebral artery stenting from a femoral approach. Initially, diagnostic imaging revealed a hypoplastic left vertebral artery terminating in the posterior inferior cerebellar artery (PICA), as well as critical stenosis caused by heavily calcified plaque in the V2 segment of the right vertebral artery. The patient underwent further postdilation and stent deployment following a successful endovascular procedure with IVL at an inflation pressure of 2 atm. The patient experienced complete symptom resolution and recovered without any complications. This case highlights the potential benefits of IVL over traditional angioplasty techniques by demonstrating its efficacy and safety in treating heavily calcified vertebral artery stenosis.
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spelling doaj-art-4b16ed8bbf23404eb04a3e25a75ff0cd2025-08-20T03:50:22ZengElsevierRadiology Case Reports1930-04332025-09-012094712471510.1016/j.radcr.2025.06.018Novel use of intravascular lithotripsy for vertebral artery stenosis: A case reportOrlando Diaz, MD0Jochen Gerstner-Saucedo, MD1Isabel Carmona2Department of Radiology, Houston Methodist Hospital, Houston, TX, USAAdvanced Imaging Lab, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Corresponding author.School of Medicine, Faculty of Health Sciences, Universidad Icesi, Cali, ColombiaSevere vertebral artery stenosis complicated by dense calcification represents a significant surgical challenge, particularly when accompanied by limited collateral circulation. Traditional high-pressure balloon angioplasty is an adequate option. However, it can increase the risk of vascular injury and it often achieves inadequate stent expansion. Intravascular lithotripsy (IVL) has recently been proposed as an alternative method for safely fracturing calcified plaques with acoustic pressure waves at lower balloon pressures. We report a symptomatic patient where IVL was used for predilation during a vertebral artery stenting from a femoral approach. Initially, diagnostic imaging revealed a hypoplastic left vertebral artery terminating in the posterior inferior cerebellar artery (PICA), as well as critical stenosis caused by heavily calcified plaque in the V2 segment of the right vertebral artery. The patient underwent further postdilation and stent deployment following a successful endovascular procedure with IVL at an inflation pressure of 2 atm. The patient experienced complete symptom resolution and recovered without any complications. This case highlights the potential benefits of IVL over traditional angioplasty techniques by demonstrating its efficacy and safety in treating heavily calcified vertebral artery stenosis.http://www.sciencedirect.com/science/article/pii/S1930043325005680Intravascular lithotripsy (IVL)Vertebral artery stenosisCalcified plaqueEndovascular procedureBalloon angioplastyStent deployment
spellingShingle Orlando Diaz, MD
Jochen Gerstner-Saucedo, MD
Isabel Carmona
Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
Radiology Case Reports
Intravascular lithotripsy (IVL)
Vertebral artery stenosis
Calcified plaque
Endovascular procedure
Balloon angioplasty
Stent deployment
title Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
title_full Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
title_fullStr Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
title_full_unstemmed Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
title_short Novel use of intravascular lithotripsy for vertebral artery stenosis: A case report
title_sort novel use of intravascular lithotripsy for vertebral artery stenosis a case report
topic Intravascular lithotripsy (IVL)
Vertebral artery stenosis
Calcified plaque
Endovascular procedure
Balloon angioplasty
Stent deployment
url http://www.sciencedirect.com/science/article/pii/S1930043325005680
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AT isabelcarmona noveluseofintravascularlithotripsyforvertebralarterystenosisacasereport