Efficacy and Safety of Excimer Laser Catheter in Patient with Complex or High Thrombotic Coronary Artery Stenosis

Abstract

Background: Indications of excimer laser use in percutaneous coronary intervention (PCI) are uncrossable device after coronary guidewire passing and thrombus modification in Acute Coronary Syndrome lesion (ACS). The excimer laser has been used for more than twenty years. However, there are inconsistent data of the efficacy and safety in an excimer laser use over the drug-eluting stent (DES) era. The authors gathered data of patient that underwent PCI using excimer laser in contemporary PCI strategy. Primary outcome was efficacy of the excimer laser defined as technical success excimer laser. Materials and Methods: The present study was a single-center retrospective analysis of 115 lesions from 112 patients over eight years with 1.1% of all PCI used excimer laser-assisted catheter. The patient data were extracted from hospital-based inpatient and outpatient medical records. A technical success excimer laser was defined as the laser catheter could cross the entire length of the stenotic lesion determined by angiographic evidence of tip catheter beyond lesion or mention in the procedural record. Results: The mean patient age was 67.1 years old with 65.2% being male and 45.2% having diabetes. The average left ventricular ejection fraction (LVEF) was 51.9%. Chronic total occlusion was 39.1% followed by 33.9% of thrombotic lesion. Intravascular imaging was used in 64.4%. Overall technical success of excimer laser was 74.8% with significantly higher success rate in thrombotic groups at 94.9 versus 64.5% (p<0.001). Overall procedural PCI success was 87.8% and no difference was observed between groups at 94.9% versus 84.2% (p=0.135). The slow flow phenomenon was significantly higher in the thrombotic groups at 17.9% versus 2.6% (p=0.007), whereas coronary perforation, major dissection, and death were not different. The authors found that older age such as 80 years or older and non-thrombotic lesions were significantly associated with technical failure of excimer laser use. Conclusion: Excimer laser had a high success rate in the thrombotic lesion and a fair success rate in non-thrombotic lesions. The PCI procedure success was high in both groups Keywords: Excimer laser; Percutaneous coronary intervention; Uncrossable lesion; Adjunctive lesion modification