Lithotripsy-assisted TAVR for severe calcific aortic stenosis. Case report

Background: TAVR has become the first option in several scenarios for the treatment of aortic stenosis. Nevertheless, calcium can lead to suboptimal outcomes concerning paravalvular leak and annular rupture. In this context, novel therapies have been emerging; intravascular lithotripsy (IVL) with Shockwave balloons is one of the most recent, with promising results, although more research is needed to propose this kind of therapy in this context. Case summary: We present the case of a 78-year-old woman with severe calcific aortic stenosis and a very small annulus, treated with intravascular lithotripsy. Sequential IVL balloon inflations (two 7.0 × 40 mm balloons, then an 8.0 × 40 mm balloon) were performed, followed by an 18 mm valvuloplasty balloon and deployment of a 23 mm Accurat Neo2. The procedure achieved an excellent final result with no complications, no paravalvular leak, and favourable early outcomes at 6 months. Discussion: This case highlights the novel use of these types of calcium-modifying devices for other than coronary and peripheral vessels with promising outcomes.