Carotid Artery Stenting for Heavily Calcified Lesions Using a Scoring Balloon: A Report of 2 Cases

Carotid artery stenting for heavily calcified lesions is challenging for interventionists. A calcium burden is associated with suboptimal dilatation, periprocedural complications, high rates of restenosis, and poor outcomes. We describe the first report of 2 cases of successful carotid artery stenting for heavily calcified lesions using a scoring balloon. The patients were both aged 75 years, 1 male and 1 female, who had experienced ipsilateral stroke prior to the procedures. They had dense calcifications at the lesions, stenosis rates of 95% (near occlusion) and 86% according to the North American Symptomatic Carotid Endarterectomy Trial criteria, and calcification arcs of 270° and 360°, respectively. Considering the heavy calcification, predilation with scoring balloons (NSE PTA balloon; Nipro, Osaka, Japan) at the rated burst pressure was performed in both cases. Sufficient dilatation was achieved, followed by carotid stent deployment (Precise Pro RX; Cordis, Miami Lakes, FL, USA). After postdilatation, the stenosis rates decreased to 21% and 23%, respectively. Although 1 patient experienced prolonged bradycardia and hypotension, they were well managed with anticholinergic and vasoconstrictive agents. Both patients remained asymptomatic. Carotid artery stenting using a scoring balloon obtained acceptable improvements in severe stenosis with heavily calcified lesions. This method could be a useful option for the revascularization of heavily calcified lesions.