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.