Abstract
ObjectivesTo evaluate the safety and efficacy of excimer laser coronary atherectomy (ELCA) in patients with in-stent restenosis chronic total occlusions (ISR CTOs).BackgroundISR CTOs are a challenge in percutaneous coronary intervention (PCI). Although they can be treated by ELCA, limited data are available on the effects of ELCA treatment in these patients.MethodsFifty-nine consecutive patients underwent PCI for ISR CTOs at Beijing Hospital between December 2017 and September 2020. According to whether or not ELCA was performed, they were divided into two groups. Quantitative coronary angiography (QCA) analyses were performed routinely, including measurement of the minimal lumen diameter and calculation of the percentage diameter stenosis. The procedural success rate, the frequency of peri-procedural complications, and the incidence rates of major adverse cardiac events (MACEs) over nine months were assessed. The primary endpoint in the study was the percentage diameter stenosis.ResultsProcedure success was achieved in most patients in both groups (75.9%). Patients in the ELCA group exhibited a lower percentage diameter stenosis (24.5 ± 9.09 vs. 35.1 ± 18.6, p = 0.048) and a larger minimal lumen diameter (2.36 ± 0.29 mm vs. 1.78 ± 0.64 mm, p < 0.001) than those in the control group and the 9-month incidence rates of MACEs did not differ (9.5% vs 15.8%, p = 0.699).ConclusionsThis study demonstrated that ELCA may be a safe and effective technique in the treatment of ISR CTOs, and the use of ELCA can achieve good immediate angiographic results, as measured by QCA, without increasing peri-procedural complications or the incidence rates of 9-month MACEs.
Highlights
Stent therapy remains the first-line treatment for patients with severe coronary heart disease
Patients in the excimer laser coronary atherectomy (ELCA) group exhibited a lower percentage diameter stenosis (24.5 ± 9.09 vs. 35.1 ± 18.6, p = 0.048) and a larger minimal lumen diameter (2.36 ± 0.29 mm vs. 1.78 ± 0.64 mm, p < 0.001) than those in the control group and the 9-month incidence rates of Major adverse cardiac event (MACE) did not differ (9.5% vs 15.8%, p = 0.699)
This study demonstrated that ELCA may be a safe and effective technique in the treatment of in-stent restenosis (ISR) chronic total occlusion (CTO), and the use of ELCA can achieve good immediate angiographic results, as measured by Quantitative coronary angiography (QCA), without increasing periprocedural complications or the incidence rates of 9-month MACEs
Summary
Stent therapy remains the first-line treatment for patients with severe coronary heart disease. Due to the diffuse neointimal proliferation or neoatherosclerosis that may occur in the stents, the most severe ISR CTOs are more challenging to treat, and the outcomes of conventional treatments such as plain old balloon angioplasty (POBA), drug-coated balloon (DCB) angioplasty, and new stent implantations are usually unsatisfactory [4,5,6]. The outcomes of patients with ISR CTOs who have undergone ELCA treatment have not been previously described. ISR CTOs are a challenge in percutaneous coronary intervention (PCI). They can be treated by ELCA, limited data are available on the effects of ELCA treatment in these patients
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