Intravascular lithotripsy-assisted carotid artery stenting for calcified carotid stenosis: a systematic review and meta-analysis.

INTRODUCTION

Severely calcified carotid artery stenosis (CCS) limits the effectiveness and safety of conventional carotid artery stenting (CAS); this systematic review and meta-analysis evaluated the efficacy and safety of intravascular lithotripsy-assisted CAS (IVL+CAS) in CCS.

EVIDENCE ACQUISITION: PubMed, Embase, MEDLINE, Scopus, and ScienceDirect were systematically searched from inception to December 2024. Eligible studies included adult patients with CCS treated with IVL+CAS and reporting at least one predefined outcome. Primary endpoints were technical success, residual stenosis <30%, and stent restenosis. Secondary endpoints included stroke, transient ischemic attack (TIA), myocardial infarction (MI), and all-cause mortality. Single-proportion meta-analyses were performed using random-effects models. Heterogeneity was assessed with the I2 statistic, and Baujat and leave-one-out sensitivity analyses were conducted when heterogeneity exceeded 35%.

EVIDENCE SYNTHESIS: Three observational studies comprising 96 patients were included. The pooled technical success rate was 99% (95% CI: 0.96-1.00; I2=0%). Residual stenosis <30% was achieved in 91% of cases (95% CI: 0.71-1.00; I2=77%). Stent restenosis occurred in 3% (95% CI: 0.00-0.07; I2=0%). The pooled incidence of TIA was 6% (95% CI: 0.01-0.11; I2=0%), and combined stroke/TIA was 4% (95% CI: 0.00-0.10; I2=45%). MI occurred in 2% (95% CI: 0.00-0.05; I2=0%), and all-cause mortality was 2% (95% CI: 0.00-0.05; I2=0%). Sensitivity analysis confirmed the robustness of the primary efficacy outcomes.

CONCLUSIONS

IVL+CAS demonstrates high procedural success, low restenosis, and favorable short-term safety in patients with CCS, supporting its role as a viable endovascular option in complex calcified carotid disease.