Rescue Cutting Balloon Angioplasty for Heavily Calcified Carotid Artery Stenosis: A Case Report and Narrative Review.

Abstract

Carotid artery stenting for heavily calcified lesions (HCLs) poses significant therapeutic challenges. We report an 83-year-old male with symptomatic carotid stenosis of HCLs. Angiography demonstrated 91% stenosis with a minimum lumen diameter (MLD) of 0.4 mm. Standard pre-dilation resulted in a "dog-bone" deformity (residual stenosis 74%, MLD 1.1 mm), preventing stent delivery. As a rescue technique, a 3.0 mm Wolverine coronary cutting balloon (Boston Scientific, Marlborough, MA, USA) was employed, successfully increasing the MLD to 2.4 mm without inducing baroreceptor-mediated hemodynamic instability. This luminal gain facilitated the successful delivery and deployment of a self-expanding stent, followed by post-dilation that achieved a final residual stenosis of 19%. A subacute in-stent thrombus detected on post-procedure day 4 resolved completely with intensified antithrombotic therapy, and at 3-month follow-up the patient had no recurrent stroke or in-stent restenosis, with a modified Rankin Scale score of 2. Supported by a literature review, this case demonstrates that newer-generation cutting balloons with improved crossing profiles offer a safe, effective rescue strategy for unyielding carotid HCLs, achieving essential luminal gain while minimizing procedural risks.