Treatment of a Heavily Calcified Celiac Artery Ostial Subtotal Occlusion Using Shockwave Lithotripsy: A Novel Approach.

PURPOSE: We present the novel use of adjunctive intravascular lithotripsy (IVL) before definitive intravascular stenting of a heavily calcified celiac artery ostial occlusion.

CASE REPORT: A 79-year-old woman presented with chronic post-prandial abdominal pain and weight loss. Selective angiography revealed a sub-totally occluded celiac artery. Percutaneous endovascular intervention of the celiac artery was attempted but was unsuccessful because of heavy calcification. The patient returned for a repeat procedure. A guidewire was successfully advanced across the sub-totally occluded ostium. A Shockwave Lithotripsy BDC 7.0-mm/60-mm balloon catheter (Shockwave Medical Inc., Santa Clara, California) was successfully used to modify the calcified plaque. Next, a stent was deployed for definitive therapy. The final angiogram showed an excellent result. The patient tolerated the procedure well and was sent home on dual antiplatelet therapy. Nine months after the procedure, she had gained weight and denied any further post-prandial abdominal pain.

CONCLUSION

IVL treatment modality to modify calcified lesions in the splanchnic circulation should be considered as a novel approach to patients in whom traditional endovascular treatment modalities are thought to be suboptimal. Further controlled studies are needed to access the safety, feasibility, and efficacy of the use of this novel technology in this vascular territory.