Excimer Laser Angioplasty Research Articles

Effect of Limb Salvage by Excimer Laser Angioplasty Plus Low-Pressure Balloon Inflation in Chronic Limb-Threatening Ischemia Patients with Infrapopliteal Vessel Disease.

Patients with chronic limb-threatening ischemia (CLTI) often exhibit long, diffuse, totally occluded and heavily calcified infrapopliteal (IP) lesions. This study evaluated limb salvage after peripheral excimer laser atherectomy (PELA) plus low-pressure balloon inflation (LPBI) without stent deployment in CLTI patients with severe IP disease. We retrospectively evaluated 70 consecutive patients with 109 IP vessels who underwent PELA plus LPBI from 2010 to 2013. Technical success was defined as at least one IP straight-line flow being achieved below the malleolus. Binary logistic regression was performed to identify factors associated with 6-month limb salvage. Of the 109 IP vessels, 100 (91.7%) were totally occluded, and none of the patients received a stent. Of the 70 patients, 20% were octogenarians, and 85.8% had a Rutherford-Becker class 5 and 6. The technical success rate was 87.1% and 6-month limb salvage rate was 78.6%. Rutherford score was negatively correlated with clinical success (adjusted odds ratio 0.24; p = 0.028). No immediate major cardiovascular events were recorded during admission. PELA plus LPBI may be a treatment option for complex IP lesions in patients with CLTI. Higher Rutherford class was correlated with a lower 6-month limb salvage rate. However, a large-scale study with a control group is needed to clarify our results.

Histological evaluation of vascular changes after excimer laser angioplasty for neointimal formation after bare-metal stent implantation in rabbit iliac arteries.

Excimer laser is used to treat coronary artery disease, especially in case of lesions with thrombus and in-stent restenosis (ISR). However, there are no in vivo preclinical studies that have evaluated the pathological reactions of the vessel wall after excimer laser ablation. Bare-metal stents were placed in the external iliac arteries of six healthy rabbits. Twenty-eight days later, excimer laser ablation was performed with low-power (45 (fluency)/25 (rate)) in one side, and high-power (60/40) in the opposite side, followed by optical coherence tomography (OCT) evaluation. Rabbits were sacrificed 15min after the procedure, and histological assessment was performed. Morphometry analysis of OCT showed similar stent and lumen size between low-power and high-power group. Histological evaluation suggested endothelial cell loss, fibrin deposition, and tissue loss. The low-power group showed significantly less pathological changes compared with the high-power group: angle of endothelial cell loss, 32.4° vs. 191.7° (interquartile range, 8.8°-131.7° vs. 125.7°-279.5°; p < 0.01); fibrin deposition, 1.1° vs. 59.6° (0.0°-70.4° vs. 31.4°-178.4°; p = 0.03); and tissue loss 0.0° vs. 18.2° (0.0°-8.7° vs. 0.0°-42.7°; p = 0.03). The pathological changes in neointima were more prominent after high-power excimer laser ablation than after low-power excimer laser. To improve safety in clinical practice, understanding the pathological changes of tissues after excimer laser in lesions with ISR is essential.

Sonodynamic therapy after catheter- based ARF excimer laser angioplasty of carotid artery, using lipid- based encapsulated docetaxel nanoparticles- assisted 5- aminolevulinic acid- mediated B- mode ultrasound- guided focused low- level confocal dual pulse electrohydraulic shock wave

Sonodynamic therapy after catheter- based ARF excimer laser angioplasty of carotid artery, using lipid- based encapsulated docetaxel nanoparticles- assisted 5- aminolevulinic acid- mediated B- mode ultrasound- guided focused low- level confocal dual pulse electrohydraulic shock wave

6111Optical coherence tomography derived predictors of restenosis after non-stenting coronary intervention with drug-coated balloon

Abstract Background One of the limitations of metallic stents including contemporary drug eluting stents lies in the permanent existence of metallic materials within the coronary arteries, which may lead to neoatherosclerosis and a long-term use of dual antiplatelet therapy. Some reports have recently suggested the efficacy and safety of non-stent strategy with drug-coated balloon (DCB) angioplasty in combination with debulking devices for de novo lesions. However, little is known about the potential risk of restenosis after percutaneous coronary intervention (PCI) with DCB. Purpose We sought to assess the predictive factors of restenosis by optical coherence tomography (OCT) after PCI with DCB instead of metallic stents. Methods We retrospectively investigated 49 de novo lesions in 38 patients treated by DCB without stent implantation in whom OCT was performed immediately after PCI and follow-up angiography was performed at median of 5.6 (3.7–6.9) months. OCT findings after PCI and the incidence of restenosis at follow-up angiography were evaluated. By means of OCT images, medial coronary dissection was defined as a dissection which reached the medial layer of the vessel, and major dissection was defined as a dissection with more than 60 degrees of the circumference of the vessel or more than 3mm in length. Restenosis was defined as more than 50% diameter stenosis evaluated by Quantitative Coronary Angiography. Results Restenosis was observed in 13 of 49 lesions (27%). In univariate logistic regression analysis, major dissection and medial dissection at the final OCT were associated with restenosis (Odds ratio [OR] 10.0; 95% confidence interval [CI] 2.5–52.6; p&lt;0.01 and OR 5.8; 95% CI 1.5–25.1; p=0.01, respectively). Lesion preparation prior to DCB were performed with rotational atherectomy (n=9), orbital atherectomy (n=2), directional atherectomy (n=4), excimer laser angioplasty (n=17), scoring balloon angioplasty (n=13), or balloon angioplasty (n=4). OCT-defined major dissection remained a significant predictor for restenosis independent of debulking devices used for the preparation (OR 8.1; 95% CI 1.2–70.2; p=0.03). Conclusions Major dissection was associated with restenosis after non-stenting PCI with DCB. Stent implantation should be considered in cases of OCT-defined major dissection. Acknowledgement/Funding None

The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography.

We aimed to evaluate the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent underexpansion as assessed by optical coherence tomography (OCT). We studied 81 patients (81 lesions with ISR, stent underexpansion, and peri-stent calcium >90°) who underwent OCT imaging both pre and post percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs. without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA: 61%, non-ELCA: 12%, p<0.01), larger final minimum lumen area (ELCA: 4.76 mm2 [3.25, 5.57], non-ELCA: 3.46 mm2 [2.80, 4.13], p<0.01), and a larger previously implanted stent area (ELCA: 6.15 mm2 [4.83, 7.09], non-ELCA: 4.65 mm2 [3.84, 5.40], p<0.01). In the multivariable model, ELCA use was associated with peri-stent calcium fracture (odds ratio 46.5, 95% confidence interval: 6.8, 315.9, p<0.001) that, in turn, was associated with final larger lumen and stent dimensions. Finally, contrast injection during ELCA was associated with multiple calcium fractures and fractures even in thicker calcium. ELCA is effective for treating ISR with underexpansion by disrupting peri-stent calcium, facilitating better expansion of the previously implanted stent.

Excimer Laser Angioplasty in Calcified Coronary Lesions: Evidence of Calcium Ablation by Optical Coherence Tomography

Excimer Laser Angioplasty in Calcified Coronary Lesions: Evidence of Calcium Ablation by Optical Coherence Tomography During percutaneous coronary revascularization, calcified lesions can prove resistant to balloon expansion and cause stent underexpansion. We report on a patient with a calcified resistant lesion in whom adjunctive therapy with excimer laser enabled successful expansion of the stent. We document in this report using optical coherence tomography imaging, the calcium ablator effects of excimer laser, an effect which has not been demonstrated thus far, to our knowledge.

Percutaneous coronary interventions over the last three decades: The adjunctive devices (role, development and perspectives)

Percutaneous coronary interventions (PCI) performed on large-scale basis in routine practice with documented long-term clinical benefit for the patient are balloon angioplasty introduced in 1977 and coronary stenting since 1986. Other coronary devices, so-called 'adjunctive', have triggered a great admiration at the time of its initial clinical application but showed to be less successful at the long-term follow-up. However, many adjunctive devices are still necessary in 1-2% of all PCI procedures for complex cases. This article is a short, comprehensive review retracing the conception and destiny of these devices. Coronary balloon catheters, a standard device with advance 'therapeutic' features comprise: cutting, drug eluting and high pressure non-compliant balloon catheters. Atherectomy devices can be directional for lesions 'debulking', rotational (Rotablator) for calcified, long lesions and recently Orbitral supposed to have less no-reflow phenomenon. Excimer Laser angioplasty for treatment of 'uncrossable' lesion was claimed much in the past. Brachytherapy is used almost exclusively for in-stent restenosis. A numerous thrombectomy and embolic protection devices exist but none has shown a proven clinical benefit in randomized studies. With an advancement in medical technology adjunctive devices will play more important role in the future, especially for recanalization of chronic total occlusion and during acute myocardial infarction.

Large coronary aneurysm following laser angioplasty of the left anterior descending coronary artery

Coronary aneurysm is a rare complication after coronary excimer laser angioplasty. A 45-year-old woman underwent laser angioplasty and bare metal direct stenting of the proximal segment of the left anterior descending artery (LAD); after 3 months, angiographic follow-up showed significant ostial stenosis of the LAD with a large sacciform aneurysm and diffuse intrastent restenosis.

Excimer laser with adjunctive balloon angioplasty and heparin‐coated self‐expanding stent grafts for the treatment of femoropopliteal artery in‐stent restenosis

The aim of the study is to evaluate the safety and effectiveness of treating femoropopliteal in-stent restenosis (ISR) with debulking with excimer laser followed by implantation of a VIABAHN endoprosthesis. The optimal treatment strategy for femoropopliteal ISR is unclear. The SALVAGE study is a multicenter prospective registry involving nine US centers. Patients with femoropopliteal ISR with moderate to severe intermittent claudication or critical limb ischemia (Rutherford categories 2-5) and an ankle-brachial index (ABI) =0.8 were treated with excimer laser and the VIABAHN endoprosthesis. The primary efficacy endpoint is primary patency at 12 months as measured by duplex ultrasonography. The primary safety endpoint is the major adverse event (MAE) rate at 30 days. Twenty-seven patients were enrolled. The mean lesion length was 20.7 ± 10.3 cm. The majority of lesions were TASC (TASC I) C and D (81.4%). All lesions were pretreated with excimer laser and percutaneous transluminal angioplasty (PTA) prior to VIABAHN implantation. Technical success was achieved in 100% of cases. There were no MAE at 30 days. Primary patency at 12 months was 48%. The ankle brachial index increased from 0.58 ± 0.24 at baseline to 0.90 ± 0.17 at 12 months. There was improvement in all quality-of-life parameters. The 12-month TLR rate was 17.4%. The strategy of excimer laser atherectomy and PTA followed by implantation of a self-expanding stent graft for the treatment of femoropopliteal ISR is safe and associated with high procedural success. Primary patency rate at 12-months was suboptimal; however, the TLR rate was low.

Catheter-based treatment of in-stent restenosis: A review

Stenting is a safe and efficient method for treatment of ischaemic heart disease. Nevertheless, it gives rise to some additional problems, especially in-stent restenosis. Several techniques including balloon angioplasty, restenting, rotaablation, excimer laser angioplasty, directional coronary atherectomy, cutting balloon angioplasty, brachitherapy and radioactive stents have been performed to treat in-stent restenosis. Balloon angioplasty is preferred in focal lesions (<10 mm). Restenting can be used only in selective cases. The clinical results of debulking techniques associated with balloon angioplasty in patients with long lesions are better especially in diabetic patients. In addition to these procedures, coronary bypass surgery in patients in-stent restenosis with multivessel disease seems to yield to best outcomes. On the other hand, current smoking, diabetes mellitus, unstable angina pectoris, and time to reintervention and in-stent restenosis in saphenous vein lesions are important negative predictors for re-restenosis. The main goal of the treatment of in-stent restenosis is the prevention of the restenosis. Unless this problem is solved the newer techniques will develop, and they will also carry on the newer problems.

Early experience with excimer laser angioplasty above and below the knee

Although considerable progress has been made in angioplasty of lower leg arteries, percutaneous treatment of atherosclerotic disease in crural vessels is not considered a routine procedure. When the disease is located only in a short crural segment, percutaneous transluminal angioplasty (PTA) may be successful, but longer segments with crural disease respond less well to PTA. The authors investigated the possibilities of using a 2.2 mm excimer laser catheter, operating at a wavelength of 308 nm, as a stand-alone technique, for angioplasty. Their aim was to establish whether by vaporizing plaque material the excimer laser could be used to create an adequate lumen diameter. They treated 10 patients, 5 for pathology above the knee and 5 below the knee. In this latter group 11 vascular segments underwent laser angioplasty.

Current status of percutaneous coronary intervention in China

Since the introduction of percutaneous transluminal coronary angioplasty (PTCA) into China in 1985 with a first report in 1986,1 there has been exponential growth in annual numbers of percutaneous coronary...

Thrombus vaporization by excimer laser angioplasty

A 70-year-old woman, with no traditional cardiovascular risk factor, came to our attention because of a non-STsegment myocardial infarction. Her cardiac history was uneventful, except the recent onset of episodes of waxing and waning epigastric pain. Of note, 2 weeks earlier, she began therapy with enoxaparin due to the suspicion of deep vein thrombosis. At admission, the patient complained of sharp, persisting pain referred to the epigastrium. Physical examination and routine blood test results were normal. Cardiac enzymes were raised (CK-MB 22.8 ng/ml) and ECG showed diffuse repolarization abnormalities. At echocardiography, mild depression of left ventricle function was found, with hypokinesis of its anterior and lateral walls. Coronary angiography (Fig. 1) revealed a critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (Panel A), thus prompting for percutaneous revascularization in the same session. After wiring of the culprit vessel, excimer laser angioplasty was performed (Panel B). Thrombus vaporization and underlying plaque debulking

Physical aspects of excimer laser angioplasty for undilatable lesions

Catheterization and Cardiovascular InterventionsVolume 71, Issue 6 p. 808-809 Coronary Artery Disease Physical aspects of excimer laser angioplasty for undilatable lesions John A. Bittl MD, Corresponding Author John A. Bittl MD jabittl@mac.com Ocala Heart Institute Munroe Regional Medical Center Ocala, FloridaOcala Heart Institute, 13013 Highway 475, Ocala, Florida 34480Search for more papers by this author John A. Bittl MD, Corresponding Author John A. Bittl MD jabittl@mac.com Ocala Heart Institute Munroe Regional Medical Center Ocala, FloridaOcala Heart Institute, 13013 Highway 475, Ocala, Florida 34480Search for more papers by this author First published: 15 April 2008 https://doi.org/10.1002/ccd.21593Citations: 10Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume71, Issue61 May 2008Pages 808-809 SCAI Member Sign in RelatedInformation

Periphere Excimer-Laserangioplastie: Indikationen, Methode und klinische Ergebnisse

Between March 1989 and January 1990, percutaneous transluminal excimer laser angioplasty was performed in 61 patients (40 men and 21 females; mean age 66 [41-86] years) with 65 peripheral arterial occlusions (iliac: 11, femoropopliteal: 48, tibial: 5, left subclavian artery: 1). The average ankle-arm index before treatment was 0.45 (0.2-0.8) for iliac, 0.52 (0-0.7) for femoropopliteal and 0.3 (0.1-0.4) for tibial occlusion. Recanalization was successful in 58 occlusions, but additional balloon dilatation was necessary in 54. The mean residual stenosis degree after laser application was 54%, after balloon dilatation 22%. Postangioplasty thromboembolism occurred in five patients. Intravascular stents were implanted in 11 patients because of extensive dissection or high-grade restenosis. After four weeks the clinical findings were improved in 54 of the 58 patients, in 47 even after six months. At that point the average ankle-arm index was 0.88 (0.5-1.1) after iliac, 0.79 (0.6-1.15) after femoropopliteal and 0.6 (0.4-0.7) after tibial recanalization.

Intravaskuläre Ultraschalldiagnostik: In-vivo-Befunde vor und nach Angioplastie bei peripherer arterieller Verschlußkrankheit

In 15 patients (13 men, two women, mean age 63 [47-75] years) with peripheral arterial occlusive disease in stages IIB-IV (Fontaine) intravascular ultrasound findings were compared with the angiographic results before and after treatment. In 12 patients stenosis (n = 10) or occlusion (n = 2) of the iliac artery (n = 2) or the superficial femoral artery (n = 10) were treated by conventional balloon angioplasty; in three patients with occlusion of the superficial femoral artery excimer laser angioplasty was performed. There was good correlation between measurements of vessel diameter by the two techniques (r = 0.93, P less than 0.001). Ultrasound scanning provided additional informations regarding the thickness of the plaque, the density or firmness of the stenosis and the degree of calcification. The therapeutic outcome was quantified by measuring the gain in lumen diameter. The authors also assessed the morphological changes following angioplasty in the vicinity of the obstructing plaque. In the light of the ultrasound findings it was considered necessary to undertake further dilatation in four out of the 12 patients treated by balloon dilatation. The results indicate that intravascular ultrasound imaging is a valuable complement to angiography for monitoring of therapeutic results after vascular interventions.

Tibial Recanalization with Excimer Laser Angioplasty

We report a case of chronic critical limb ischemia (CLI) due to occlusive tibial artery disease that we treated with an excimer laser with good clinical results. The current status of laser technology in the treatment of infrainguinal arterial disease is reviewed, and our approach to the use of this device in these challenging patients is presented. Data that indicate the value of this modality in the treatment of patients with CLI are discussed.

Looking back at the past and seeking for greater development: in commemoration of the 120th anniversary of the Chinese Medical Journal

Looking back at the past and seeking for greater development: in commemoration of the 120th anniversary of the Chinese Medical Journal

Limb Salvage Following Laser-Assisted Angioplasty for Critical Limb Ischemia:Results of the LACI Multicenter Trial

To evaluate the effectiveness of laser-assisted angioplasty for patients with critical limb ischemia (CLI) who were poor candidates for surgical revascularization. A prospective registry at 14 sites in the US and Germany enrolled 145 patients with 155 critically ischemic limbs; the patients were poor candidates for bypass surgery owing to inadequate target vessel or saphenous vein, prohibitive cardiac disease, or significant comorbidities (ASA class 4). Additional comorbid risk factors included diabetes in 66%, hypertension in 83%, previous stroke in 21%, and myocardial infarction in 23%. Endovascular treatment included guidewire traversal and excimer laser angioplasty followed by balloon angioplasty with optional stenting. Occlusions were present in 92% of limbs. A mean of 2.7+/-1.4 lesions were treated per limb; the total median treatment length was 11 cm (mean 16.2, range 0.2-123). Stents were implanted in 45% of limbs. Procedural success, defined as <50% residual stenosis in all treated lesions, was seen in 86% of limbs. At 6-month follow-up, limb salvage was achieved in 110 (92%) of 119 surviving patients or 118 (93%) 127 limbs. Excimer laser-assisted angioplasty for CLI offers high technical success and limb salvage rates in patients unfit for traditional surgical revascularization.

The Effect of Interventional Treatment in Acute Myocardial Infarction on ST Resolution: A Comparison of Coronary Angioplasty with Excimer Laser Angioplasty

The treatment methods for acute myocardial infarction (MI) have started to change in the new millennium. Myocardial perfusion (ST-segment resolution) is the target rather than achieving TIMI-III flow in the infarct-related artery. In this study the authors compared the effect of percutaneous transluminal coronary angioplasty (PTCA) and excimer laser angioplasty (ELCA), which was accepted as one of the thrombolysis methods, on ST-segment resolution. A stent was applied after ELCA to 36 patients (4 women, 32 men; mean age 50.44 +/-9.8 years) in group I and a stent was applied after balloon angioplasty to 44 patients (5 women, 39 men; mean age 50.77 +/-12.2 years) in group II. Fisher's exact test was used in the analysis of data, and p<0.05 was accepted as significant. There was no difference between the groups with respect to symptom duration, time to angioplasty, risk factors, infarct localization, stent diameter, and length. TIMI-III flow was achieved in 33 patients (92%) in group I and in 40 patients (91%) in group II. There was no statistical difference in TIMI flow between the groups. In group I, complete ST resolution was observed in 75% (27/36) of the patients, partial resolution in 22% (8/36), and resolution was unsuccessful in 3% (1/36). In group II, complete, partial, and unsuccessful ST resolution were 41% (18/44), 45% (20/44), and 14% (6/44), respectively. The mean ST resolution was 82.78 +/-11.8% in group I and 66.36 +/-10% in group II (p=0.001). ST segment resolution, which is a good predictor of tissue perfusion, was higher with ELCA than with balloon angioplasty. These findings should be supported by large randomized studies.