Case report
Preserving options in no-stent zones
Bella Huasen (Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK) outlines a recent femoropopliteal occlusion case, during which Shockwave Intravascular Lithotripsy (IVL; Shockwave Medical) proved to be an effective vessel preparation strategy in this ‘no-stent zone’. THERE ARE NO SIGNS OF atherosclerotic disease regression internationally, with an increasing number of chronic limb-threatening ischaemia (CLTI) patients presenting with heavily calcified disease and ulcerations. Whilst healthcare authorities work on prevention strategies, we as endovascular clinicians must work hard on ‘cures’ to avoid amputation. In our trust, cases are discussed at the CLTI
multidisciplinary team meeting every week, and those with calcific disease are listed for endovascular intervention with Shockwave IVL. Bella Huasen IVL is helping fight against calcium by increasing vessel wall compliance, thus minimising significant dissection and procedural complications and
resulting in acute procedural success with a significantly reduced need for stenting. In our CLTI algorithm, IVL is not classed as an alternative but as an adjunctive therapy to our current treatment pathway by providing consistent vessel preparation for a definitive treatment strategy. This is a simple and effective tool, often used as part of day-case work, and so the learning curve is short. We present an 85-year-old female with multiple comorbidities including hypertension, diabetes mellitus type 2, and cardiac disease, who came to our care with Rutherford 5 CLTI involving painful ulcers affecting the second and third toe, limiting mobility and self-confidence. Computed tomography angiography (CTA) imaging confirmed an occlusive lesion of the distal superficial femoral artery (SFA) into the proximal popliteal artery (POPA) with little flow into the foot. We were keen to avoid
Figure 1. Baseline angiography
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Figures 2–5. Lithotripsy catheter is introduced and used throughout the entire length of the lesion with the most significant areas treated multiple times. Attention is paid to overlapping and good wall apposition
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March/April 2023
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