Abstract
This study aims to test the hypothesis that the effect of excimer laser coronary angioplasty (ELCA) not only vaporizes thrombi and their underlying coronary plaque, it also changes their quality. We performed a series of cross-sectional analyses in 52 lesions in 51 patients before and after ELCA with integrated backscatter-intravascular ultrasound (IB-IVUS). The constituent parts of the plaque can be assessed by IB-IVUS (i.e., calcified, fibrous, lipid) according to integrated backscatter values. Minimum lumen diameter, lumen volume and vessel volume expanded after ELCA, while plaque volume did not significantly decrease. There was also a decrease of ‘lipid’ component (35.4–30.3%, P < 0.001) and an increase of IB-IVUS-derived ‘fibrous’ part (34.5–38.3%, P < 0.001). These results may help in understanding plaque change after ELCA. Excimer laser coronary angioplasty seems to contribute to the modification of coronary plaque composition in addition to debulking it.
Highlights
Abbreviations AP Angina pectoris ELCA Excimer laser coronary angioplasty integrated backscatter-intravascular ultrasound (IB-IVUS) Integrated backscatter-intravascular ultrasound percutaneous coronary intervention (PCI) Percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction thrombolysis in myocardial infarction (TIMI) Thrombolysis in myocardial infarction UAP/NSTEMI Unstable angina pectoris/non-ST-segment elevation myocardial infarction
Cases were excluded if the patient required cardiopulmonary resuscitation, if the target lesion was restenosis, if PCI was to de novo branch lesions in which the main vessel had been revascularized before, or if balloon angioplasty was performed between the IVUS procedures being compared
Conventional IVUS showed that the minimum lumen area (1.34–2.47 mm2) and the lumen volume (17.8–24.3 m m3) increased during ELCA
Summary
Abbreviations AP Angina pectoris ELCA Excimer laser coronary angioplasty IB-IVUS Integrated backscatter-intravascular ultrasound PCI Percutaneous coronary intervention STEMI ST-segment elevation myocardial infarction TIMI Thrombolysis in myocardial infarction UAP/NSTEMI Unstable angina pectoris/non-ST-segment elevation myocardial infarction. To evaluate the effect of ELCA on the plaque in media of the coronary artery, we used integrated backscatter-intravascular ultrasound (IB-IVUS). We hypothesized that the effect of ELCA might be in part due to debulking the thrombus and its underlying plaque tissue, and by its modification. Excimer laser coronary angioplasty (ELCA) is reported to be useful in percutaneous interventions [1, 2]. This method of atherectomy uses the energy of 308-nm wavelet ultraviolet from excited xenon chloride molecules.
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