Carotid artery stenting for heavily calcified lesions after plaque modification using scoring balloon angioplasty

Abstract

Background

Carotid artery stenting (CAS) for heavily calcified lesions (HCLs) presents technical challenges. The NSE PTA balloon (Nipro, Osaka, Japan), a scoring balloon designed for plaque modification, is commonly used in coronary and peripheral interventions. This study evaluated the feasibility and safety of using this balloon in CAS for HCLs.

Methods

We retrospectively analyzed 10 CAS procedures using the NSE PTA balloon for carotid artery stenosis with HCLs. Inclusion criteria were concentric calcified lesions occupying ≥270° of the vessel circumference. Efficacy outcomes included procedural success rate, stenosis improvement after NSE PTA (plaque modification prior to stenting), final residual stenosis, and 6-month restenosis. Safety outcomes included 30-day major adverse events and secondary outcomes, including severe bradycardia and hypotension.

Results

The median patient age was 77 years (interquartile range: 74–83), with 90% male, and the median arc of calcification was 311° (294–334°). All 10 procedures achieved technical success. The median stenosis rate improved significantly from 86% (80–87%) preprocedure to 67% (60–69%) post-NSE PTA (P = .018) and to 29% (25–37%) after stent placement (P = .018). No major perioperative adverse events occurred within 30 days. Secondary adverse events, such as hypotension, were transient and successfully managed. At 6 months, no significant restenosis was observed.

Conclusions

This preliminary study demonstrated that the NSE PTA balloon for plaque modification in CAS for carotid artery stenosis with HCLs achieved high technical success and favorable safety outcomes. This technique appears to be a promising and easily applicable treatment option for complex calcified lesions.