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Abstract
Introduction Management of symptomatic intracranial artery stenosis remains controversial, since angioplasty and stenting are associated with high complication rates.
We report an off-label use of Shockwave-intravascular-lithotripsy (S-IVL), a coronary calcium modification balloon-catheter, as an effective bail-out technique in patient with a known calcific basilar-artery-stenosis (BAS), responsible for acute ischemic stroke.
Case Description A 78-year-old man with a known BAS in best medical therapy, presented within 6 hours from the onset with left hemisyndrome and impaired consciousness due to a basilar artery occlusion at the level of a large eccentric calcific plaque (figure 1A-1B).
After an effective mechanical thrombectomy a tight stenosis persisted (figure 1C-1D). A predilation was performed using non-compliant 3 mm NeuroSpeed Balloon-Catheter (Acandis) (figure 1E), followed by stent deployment (4.5 mm Atlas, Stryker) over the NeuroSpeed (figure 1F). Due to resistant stenosis an unsuccessful angioplasty was carried out with a 3.5 mm non compliant balloon catheter (pITA, Phenox)(figure 2 A-B).
After these attempts we decide to perform a low pressure intravascular lithotripsy with a 4 mm S-IVL, completely resolving the stenosis and a 24h CT revealed no cerebral infarction (figure 2 C-D-E-F).
Results In calcified intracranial stenosis aggressive balloon dilation in eccentric calcified lesions may increase the risk of edge dissection and vessel rupture.
Some case series of successful use of S-IVL for extracranial carotid stenosis have been published, however, its use in cases of severe intracranial arterial stenosis has never been considered. Further investigation is warranted to fully elucidate the risks and benefits of this treatment approach.
Disclosure of Interest no.