Pre-stenting lesion preparation using shockwave intravascular lithotripsy in severely calcified superior mesenteric artery stenosis

BACKGROUND: Intravascular lithotripsy (IVL) is an emerging technique for modifying heavily calcified arterial lesions, with primary application in peripheral arteries. We report the use of IVL for lesion preparation prior to stenting in a patient with severely calcified superior mesenteric artery (SMA) stenosis. CASE PRESENTATION: A 66-year-old man with type I adenocarcinoma of the esophagogastric junction (AEG Type I) and neoadjuvant FLOT chemotherapy was scheduled for Ivor Lewis esophagectomy. Preoperative CT angiography (CTA) revealed a high-grade ostial SMA stenosis due to extensive atherosclerotic calcification. To mitigate the risk of postoperative mesenteric hypoperfusion, percutaneous endovascular revascularization was performed. Following initial predilatation, IVL using a Shockwave 5.5 × 60 mm balloon catheter was employed for lesion preparation. Subsequently, an 8.0 × 24 mm balloon-expandable stent was successfully deployed with low-grade residual stenosis and no complications. CONCLUSION: This case demonstrates that IVL represents a feasible and effective adjunct in the management of severely calcified visceral arterial lesions. It facilitates adequate lesion preparation and enables full stent expansion, even when the IVL balloon diameter is notably smaller than the stent diameter. This potentially represents a less traumatic approach to the vessel than alternative techniques. IVL may therefore be considered a therapeutic option in selected patients.