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

Sep 30, 2026

Uploaded by Asher

Intravascular lithotripsy (IVL) modifies heavily calcified arterial lesions and is primarily used in peripheral arteries. The letter reports IVL-assisted lesion preparation before stenting in a patient with severely calcified superior mesenteric artery (SMA) stenosis. After predilatation, a Shockwave 5.5 × 60 mm balloon catheter was used, followed by successful deployment of an 8.0 × 24 mm balloon-expandable stent with low residual stenosis and no complications. The case highlights feasibility and effectiveness, supporting IVL as a less traumatic adjunct when the IVL balloon diameter is smaller than the stent diameter.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Letter to the Editor

Background

Case presentation

Conclusion

Case presentation (continued)

Figures

Terzis et al. CVIR Endovascular (2026) 9:2 [https://doi.org/10.1186/s42155-025-00622-2](https://doi.org/10.1186/s42155-025-00622-2) CVIR Endovascular LETTER TO THE EDITOR Open Access Pre-stenting lesion preparation using shockwave intravascular lithotripsy in severely calcified superior mesenteric artery stenosis Robert Terzis1* , Robert Wawer Matos Reimer 1, David Maintz 1 and Erkan Celik1 Abstract 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 stentingin 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. Background Chronic mesenteric ischemia (CMI) commonly results from atherosclerotic narrowing of the mesenteric arteries and typically presents with postprandial pain and weight loss [1]. However, incidental SMA stenosis may also be detected during cancer staging or preoperative imaging. The SMA is the primary vessel supplying the small intestine. Its obstruction, especially in the context of limited collateral flow, can lead to clinically significant ischemia during physiologic stress, such as major abdominal surgery [2, 3]. *Correspondence: Robert Terzis [robert.terzis@uk-koeln.de](robert.terzis@uk-koeln.de) 1 Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, Cologne 50937, Germany Endovascular treatment options include percutaneous transluminal angioplasty (PTA) with stent placement [4]. However, dense calcification poses technical challengesand increases the risk of perforation, suboptimal expansion, recoil, or dissection [4]. Intravascular lithotripsy (IVL) has recently emerged as an innovative approach that facilitates calcium modification using sonic pressure waves to fracture intimal and medial calcifications, thus enhancing vessel compliance prior to stenting [5, 6]. Case presentation A 66-year-old male patient was diagnosed with adenocarcinoma of the esophagogastric junction type I (AEG Type I), with tumor extension from 40 to 44 cm from the alveolar ridge. He completed neoadjuvant chemotherapy per FLOT protocol. Follow-up CT staging revealed a © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unl

FAQs

What problem does the document address?

It addresses pre-stenting preparation for a severely calcified superior mesenteric artery (SMA) stenosis, where dense calcification makes standard endovascular treatment challenging.

How was intravascular lithotripsy used in the reported case?

After initial predilatation, Shockwave 5.5 × 60 mm IVL balloon catheter was applied to modify the calcified lesion before stent deployment.

What was the outcome after stenting?

An 8.0 × 24 mm balloon-expandable stent was successfully deployed, achieving low-grade residual stenosis with no complications reported.

Sep 30, 2026

Uploaded by Asher