Intravascular Lithotripsy Does Not Avoid Stenting in the Common Femoral Artery.

PURPOSE: Calcified occlusive lesions are independently associated with higher failure rates of endovascular treatment. Intravascular lithotripsy (IVL) is emerging as a promising innovation in calcified vessel preparation. The aim of this study was to assess the safety and efficacy of IVL in the treatment of calcified common femoral artery (CFA) lesions, and to evaluate the role of adjunctive stenting in maintaining mid-term patency.

METHODS

This is a retrospective, single-center observational study. Demographic, procedural (before and after IVL), and follow-up data were analyzed. IVL was used for moderate or severe calcifications (plaque > 180° of circumference) according to the PARC (Peripheral Academic Research Consortium) classification. Results are expressed as means with standard deviations.

RESULTS

From September 2021 to May 2024, 37 calcified lesions in 30 patients were treated with IVL. Most presented with ischemic rest pain (78.4%, N = 29). Severe calcifications were present in 75.7% (N = 28) of cases. After IVL, vessel preparation was satisfactory (residual stenosis ≤ 30% without flow-limiting dissection) in 81% (N = 30) of lesions, with a median luminal gain of 50% [IQR: 40-66%]. No intra or postoperative complications were observed. Among the 37 lesions, 45.9% (N = 17) required stenting, either planned or as bail-out for significant recoil. At 6 months, primary patency was significantly higher in the stenting group versus the non-stenting group (100%vs.75%, p = 0.049). Kaplan-Meier analysis confirmed the benefit of stenting in maintaining mid-term vessel patency (log-rank p = 0.02).

CONCLUSION

Our study highlights that an aggressive stenting strategy following IVL in the CFA should be favored. These findings question the commonly held preference for a "leave nothing behind" strategy associated with IVL.