Excimer Laser Coronary Atherectomy Research Articles

An analysis of long-term clinical outcome following the use of excimer laser coronary atherectomy in a large UK PCI center.

Excimer laser atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI). Despite this there are a lack of contemporary outcome data, particulary longer-term, forpatients treated with ELCA PCI. To evaluate the contemporary use ofELCA in PCI, the frequency of periprocedural complications and the longer-term outcomes associated with ELCA PCI. This was a retrospective study that included all patients undergoing PCI (with or without ELCA) between April 2005 and May 2021. Relevant features from all cases were downloaded from the patient record and matched to hospital data on mortality on November 22, 2022. Kaplan Meier curves were used to compare mortality between the ELCA PCI and non-ELCA PCI cohorts with a landmark at 1 year. Multivariable Cox regression was performed to assess whether ELCA PCI was independently associated with long-term mortality. There were 21,256 patients in this analysis, of which 448 (2.1%) were treated with ELCA PCI. ELCA PCI was associated with a higher frequency of any periprocedural complication. Median follow-up was 2812 days (IQR, 1577-4245 days) with higher mortality in ELCA PCI (38.2% vs. 29.0%, p < 0.001). However, on multivariable analysis, ELCA PCI was not independently associated with long-term mortality. The TVR frequency in ELCA PCI was 16.7% but TVR was significantly higher for cases of in-stent restenosis (ISR) (29.5%). Despite ELCA PCI being used in higher risk populations with complex coronary artery disease there was no long-term increased mortality associated with the use of this device. ELCA PCI for ISR is highly effective and safe although TVR in this cohort remains high in long-term follow-up.

LASER CORONARY ATHERECTOMY AND POLYMERIC CORONARY WIRES IN UNCROSSABLE LESIONS – A WORD OF CAUTION

Abstract Background Excimer laser coronary atherectomy (ELCA) represents one of the last available options in case of balloon uncrossable lesions but no bench testing or clinical experience has been reported with polymeric wires. We aimed to assess whether ECLA use can disrupt or melt the cover and coating of coronary wires. Methods A total of 22 wires (10 polymer–jacketed and 12 hydrophilic non polymeric) were tested in an uncrossable lesion model. Two ELCA tests were performed over each wire at 8 and 4 cms from the tip with low and high settings, respectively. Microscopic analysis was performed at baseline images and after each test. Wire disruption was classified as Grade 1 (superficial scratches), Grade 2 (coil damage or solution of continuity of the polymeric cover) and Grade 3 (wire rupture/core disruption or de–coiling). Results After 44 ELCA simulations, wire disruption occurred in 16 cases (36.3%). Overall, events were more common for polymer–jacketed than for hydrophilic wires (12 vs 4, p=0.004). No grade 3 events occurred. Grade 2 events occurred in 9 cases (20.5%) and were more frequent with polymer–jacketed wires (8 vs 1, p=0.006). With low ELCA settings only polymer–jacketed wires suffered disruption (5 vs 0, p=0.009). With higher settings 11 events occurred (7 of Grade 2 and 4 of Grade 1) and incidence of grade 2 events was higher for polymer–jacketed wires (6 vs 1, p=0.02). Conclusions ELCA might be a safe option for coronary uncrossable lesions but its use with high settings over polymer–jacketed wires is discouraged.

A novel approach to saline/contrast delivery in excimer laser coronary atherectomy (ELCA) to enhance efficacy: MAXCon ELCA technique.

The advent of excimer laser coronary atherectomy (ELCA) nearly four decades ago heralded a novel way to treat complex lesions, both coronary and peripheral, which were previously untraversable and thus untreatable. These complex lesions include heavily calcified lesions, ostial lesions, bifurcation lesions, chronic total occlusions, in-stent restenosis (including stent underexpansion), and degenerative saphenous vein grafts. We discuss the technology of ELCA, its indications, applications, and complications, and suggestthe"MAXCon ELCA" technique for better outcomes without increased risk. Lastly, we present a case of MAXCon ELCA effectively treating a complex lesion.

Excimer laser coronary atherectomy in severely calcified lesions: time to bust the myth

Excimer laser coronary atherectomy in severely calcified lesions: time to bust the myth

Combined Rotational excimer lASER coronary atherectomy (RASER) in non-crossable, non-dilatable coronary artery disease: observations from a single center.

Balloon non-crossable stenoses represent a challenging subset of coronary artery disease (CAD). They are clinically associated with patients who are older, frailer, and with multi-morbidities, and angiographically with increased tortuosity and coronary artery calcification. Combined rotational (RA) excimer laser coronary atherectomy (ELCA), or RASER, may facilitate stent delivery and deployment in non-crossable, non-dilatable severely calcified lesions. In this study, we assessed preliminary safety and efficacy of the RASER hybrid technique. RASER feasible percutaneous coronary intervention (PCI) procedures performed at a large tertiary hospital in the northeast of England were retrospectively analyzed from September 1, 2008, to February 28, 2022. Major endpoints were in-hospital death from any cause, as well as procedural and angiographic success, defined by stent delivery with less than 50% residual stenosis and without clinical or angiographic complications, respectively. From 74 unique cases, there were 28 RASER, 24 ELCA/RA, 16 balloon angioplasty ± stenting, and 6 medically treated patients. In-hospital mortality rate was 5.2%, including 1 ELCA- and 3 RASER-treated patients. Successful stent delivery was achieved in significantly more RASER-treated patients compared to ELCA/RA- or balloon-treated patients: 96.4% (27/28), 25% (6/24), and 31.3% (5/16) respectively (P less than .001). In our retrospective, single-center study, patients with CAD who were deemed appropriate for RASER PCI had a high peri-procedural mortality rate. In this context, adjunctive RASER therapy provides acceptable safety and efficacy as a bailout strategy, with at least 3 out of 5 patients achieving satisfactory procedural and angiographic results. Randomized controlled trials are needed to comprehensively compare the clinical outcomes of high-risk RASER PCI vs conservative medical therapy.

Laser ablation on vascular diseases: mechanisms and influencing factors.

Vascular diseases, such as venous insufficiency and coronary artery diseases, have been threatening the health of people. Efficient treatment with proper postoperative care is required to relieve the pain of the patients. Traditionally, venous insufficiency is treated with ligation and stripping, an open surgery whose complication rate cannot be ignored. Coronary artery disease is often treated with balloon angioplasty during which undilatable lesions may be encountered, limiting the efficacy of this approach. With advances in laser photonics and percutaneous coronary intervention procedure, laser ablation is emerging as an alternative and adjunctive therapy for these diseases. Endovenous laser ablation has the advantages of high success rate, low complication risk, and fast postoperative recovery. Laser ablation in arteries can handle uncrossable or undilatable lesions with a low incidence of serious complications. In this review, previously published research concerning vascular diseases and their therapies are analyzed in order to provide a clear explanation of the mechanisms and merits of laser ablation. For endovenous laser ablation, the main mechanisms are steam bubbles, heat conduction, and heat pipe, and three main influencing factors are wavelength, fiber types, and laser energy density. For excimer laser coronary atherectomy, the main mechanisms are photochemical, photothermal, and photomechanical effects, and three main influencing factors are catheter, medium, and laser parameters.

The efficacy of excimer laser coronary atherectomy in ST-elevation myocardial infarction: a report from the STELA registry

Abstract Backgrounds Previous studies have demonstrated potential effect of excimer laser coronary atherectomy (ELCA) to reduce thrombus burden within the vessel, and ELCA has been used during primary PCI for acute coronary syndrome. Especially, the culprit lesions of ST-segment elevation myocardial infarction (STEMI) are generally accompanied by large thrombus burden. Nevertheless, the clinical effectiveness of ELCA use for the culprit lesions of STEMI has not been elucidated. Purpose To investigate the clinical outcomes of the STEMI patients who were treated with ELCA during primary PCI in comparison with those treated without ELCA. Methods We conducted the registry study of STEMI for the assessment of the efficacy of ELCA, which was an observational multicenter registry of the consecutive patients undergoing primary PCI for STEMI within 24 hours from the onset between 2015 and 2019. The patients were divided into two groups according to the use of ELCA during primary PCI: ELCA group and non-ELCA group. The primary endpoint was the major adverse cardiovascular event (MACE), which was defined as the composite of cardiovascular death (CVD), target vascular revascularization and non-fatal AMI. Propensity score (PS) matching was performed to adjust the bias of confounding factors using 1:1 nearest-neighbor matching without replacement. PS was yielded from clinical characteristics, baseline angiographic findings, and hemodynamic status that were imbalanced between the two groups. Results A total of 2593 patients, 424 patients in ELCA group and 2169 patients in non-ELCA group, were included in the analysis. PS matched cohort comprised 824 patients including 412 ELCA and 412 non-ELCA group. Median follow-up duration in the total cohort was 816 (394-1388) days. In the total cohort, baseline characteristics showed that younger age, less prevalent hypertension, and more frequent prior statin use in ELCA group than in non-ELCA group. In terms of clinical outcomes, ELCA group showed a significantly lower rate of CVD than non-ELCA group (4.3% vs 7.5%, P for log-rank = 0.03), whereas MACE rate was similar between the two groups (HR:1.00 95%CI 0.74-1.34, P=0.99). In the PS matched cohort, the baseline characteristics were well balanced. Clinical outcomes including MACE and CVD were comparable between the two groups (MACE HR:1.13 95%CI 0.76-1.66, P=0.53 and CVD HR0.70 95%CI 0.38-1.29 P=0.25). In the subgroup analysis, MACE rate was lower in ELCA group than in non-ELCA group in the patients who presented with Killip class III or IV (P for interaction &amp;lt;0.01) (Abstract Picture 1). Conclusions The use of ELCA was not associated with improved MACEs in both total cohort and the PS matched cohort, whereas subgroup analysis suggested a potential benefit of ELCA in patients with heart failure. Further prospective investigations are warranted.Forest Plots for Subgroup Analysis

Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu’s arteritis: a case report and review of the literature

Takayasu’s arteritis (TAK) is a rare chronic granulomatous arteritis that mainly affects the aorta and its major branches. Coronary artery (CA) involvement can be observed in 10–25% of TAK patients. We report a 21-year-old young female who was previously diagnosed with TAK and severe left main coronary artery (LMCA) stenosis and underwent numerous percutaneous coronary interventions (PCIs) in our hospital due to in-stent restenosis (ISR). This time, an excimer laser coronary atherectomy (ELCA) and drug-coated balloon (DCB) dilation was taken at the LMCA for the ISR. The blood flow was smooth after the operation, and she was symptom-free after discharge. Unfortunately, 5 months later, severe intimal hyperplasia was still seen in the stent of LMCA and left anterior descending (LAD) coronary artery. A coronary artery bypass graft surgery (CABG) was performed, and she has been symptom-free ever since. ELCA plus DCB is one of the novel ways we first reported. However, ensuring long-term inflammation control is equally important to restore blood flow. The combination of revascularization and anti-inflammation/immunosuppression is recommended to improve the outcomes of TAK patients with CA involvements.

Complex, high-risk, and indicated percutaneous coronary angioplasty in essentially calcified stented coronary lesions using excimer laser coronary atherectomy with contrast mix injection.

Complex, coronary stenosis remains a technical challenge that may be responsible for in-stent restenosis and vessel thrombosis. Here we investigated the efficacy and safety of excimer laser coronary atherectomy (ELCA) with contrast mix injection for improving vessel wall stent apposition in undilatable, mostly calcified lesions. To assess ELCA with contrast mix injection in complex, stented, calcified coronary lesions. This prospective single-center observational study enrolled 52 consecutive patients (73 lesions), with suboptimal stents implanted in de novo lesions and lesions requiring in-stent restenosis (ISR) due to stent underexpansion using all available means to achieve an optimal result. Patients presenting with ST-segment elevation myocardial infarction were excluded. All patients underwent coronary angiography 6 months after ELCA with intravascular ultrasound or optical coherence tomography study. We used contrast media mixed with saline (25-75%) to supply maximum laser energy output when a standard approach was unsuccessful. Procedural success was defined as relative stent expansion of > 80% minimal stent area (MSA) divided by average reference lumen area. Procedural success was achieved in all cases. The cross-sectional area measured in treated segment improved significantly from 2.9 (0.72) mm2 to 7.3 (0.79) mm2 after ELCA. The in-hospital device-oriented major adverse cardiac event (DOCE) rate was 9.6%. No vessel perforation occurred during ELCA. After 6 months, the DOCE rate was 13.4%, while the rate of target lesion revascularization (TLR) was 8.2%. This registry confirms the efficacy and safety of ELCA with contrast mix injection as a possible approach for stent expansion/ISR in failed PCI.

773 CONTRAST-ENHANCED EXCIMER LASER CORONARY ANGIOPLASTY IN THE TREATMENT OF HEAVILY CALCIFIED LESIONS: A STEPWISE APPROACH

Abstract Introduction The treatment of heavily calcified lesions is a challenge for the interventional cardiologist. The Excimer laser coronary atherectomy (ELCA) is a plaque modification tool and the main mechanism of action seems to be the photomechanical delivering acoustic pressure with a mechanical disruption of the plaque in front of the catheter tip. Objective To evaluate the effectiveness of the contrast-enhanced ELCA by a stepwise approach, with incremental frequency/fluency in the treatment of calcified lesions in different contexts. Methods We retrospectively enrolled consecutively all patients undergoing contrast-enhanced ELCA-assisted PCIs between 2018 and 2021 at the Cardiology Unit of “Umberto I” Hospital of Syracuse (Italy). The frequency/fluency ELCA profile used with a stepwise approach were 50/50, 60/60, 70/70 and 80/80. ELCA technical success was defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. Procedural success was defined as &amp;lt;30% residual stenosis after laser and adjunctive therapy. Clinical success requested procedural success with absence of major adverse cardiac events at hospital discharge. Major adverse cardiac events included death of all causes, myocardial infarction, need for target lesion revascularization, tamponade, and life-threatening arrhythmias. Results We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI. 58% of the patients had acute coronary syndrome and 42% had chronic coronary syndrome. The left anterior descending artery was the target vessel in 42.1% of cases, the right coronary artery in 26.3%, the circumflex in 10.5%, and the left main artery in 2.3%. The main indication for ELCA was intrastent restenosis (56.2%). The median stenosis was 90% (80% – 90%). The ELCA catheter tip was 0.9 mm and 1.4 mm was employed in the 89.5% and 10.5% of cases respectively. The most used frequency/fluency profile was 70/70 (39.5%) followed by 60/60 (31.6%), 50/50 (15.8%) and 80/80 (13.2%). Use of contrast-enhanced ELCA was associated with high technical success rate (97.4%), procedural success rate (93.7%), and clinical success rate (97.1%). Conclusions In Conclusion, the contrast-enhanced ELCA seems to be a safe and effective treatment for management of calcified lesions.

Excimer Laser coronary atherectomy as adjunctive treatment of severe stent underexpansion with bulky calcification

Excimer Laser coronary atherectomy has improved significantly in recent years, emitting high-energy ultraviolet and short wavelength with less penetration and heat emission, ultimately leading to less tissue damage and fewer complications. We described a case of a 66-year-old male patient, former smoker and suffering from hypertension, diabetes mellitus, and dyslipidemia. He underwent multiple percutaneous coronary interventions in the left anterior descending artery with bare metal and drug-eluting stents. In the last percutaneous coronary intervention, the stent was underexpanded and the patient presented acute stent thrombosis and recurrent stent restenosis. New percutaneous coronary interventions with adjunctive Excimer Laser coronary atherectomy were undertaken due to refractory angina, using progressive load and saline injection, followed by subsequent high-pressure balloon inflation and drug-eluting stent implantation with an excellent result. At 8-month follow-up, the patient was asymptomatic.

Intracoronary Brachytherapy for Recurrent DES Restenosis

<h3>Purpose/Objective(s)</h3> This study aims to report outcomes of intracoronary brachytherapy (ICBT) in treating drug-eluting stent (DES) in-stent restenosis (ISR) and to identify correlated, patient and treatment factors. <h3>Materials/Methods</h3> Patients undergoing ICBT for recurrent DES ISR from 2010 to 2021 were included in this single-institution retrospective PCI registry. Most lesions had ≥2 layers of pre-existing DES and were treated with balloon angioplasty, excimer laser coronary atherectomy (ELCA), or rotablator followed by ICBT at a dose of 18.4 Gy (vessel diameter ≤ 3.35mm) or 23 Gy (vessel diameter >3.35mm) delivered 2 mm from source center at the site of ISR. After March 2015, the standard dose was changed to 23 Gy or 25 Gy. All patients had operator-determined final target lesion stenosis <50%, and there were no in-hospital deaths. The primary outcome was 3-year target lesion failure rate (cardiac death, target lesion revascularization, or target vessel myocardial infarction). Secondary endpoints where target lesion failure (TLF) rate at one year, any cause mortality, and cardiac mortality. Cox regression analyses were used to determine covariates, correlated with TLF rate, with p<0.05 considered significant and 0.05<p<0.10 considered a trend. The covariates were pre-specified based on previous studies and limited in number to avoid over-modelling. Analysis was performed using IBM statistical software and SYSTAT version 13. <h3>Results</h3> There was a total of 330 patients with 345 treated lesions. The mean age was 66 years, and 70.3% were men. At 3 years, all-cause mortality was 22.6% and cardiac mortality was 13.5%. The mean time to ISR from last failed DES implantation was 284 days. 255 of the 285 patients with known number of stent layers had at least 2 stents at the target lesion. Most of the patients had advanced coronary disease; 62% had prior bypass surgery. Rate of TLF was 18% at 1 year and 46% at 3 years. More stent layers were found to be correlated with 3-yr TLF (p=0.045). Lower radiation dose was negatively correlated with 1-yr TLF (p=0.039) but not at 3 years. TLF was trended higher if the target lesion was a vein graft (p=0.097). Final diameter of stenosis of the target lesion was not correlated with TLF at 1 year or at 3 years. <h3>Conclusion</h3> ICBT for recurrent DES-ISR provided low recurrence rates at 1 year, which increased substantially by 3 years. Outcomes were significantly better with lower numbers of stent layers at the target lesion but not with greater final diameter of target lesion stenosis.

Initial experience of a single referral centre using excimer laser coronary atherectomy-assisted expansion in undilatable stents: Excimer laser in undilatable stents.

Undilatable stents with severe peri-stent calcification are an important cause of target lesion failure and therapeutic options are limited. We report our initial experience with the safety and efficacy of excimer laser coronary atherectomy (ELCA)-assisted expansion of undilatable stents. ELCA was performed with saline, blood and contrast-enhanced trains. All lesions were post-dilated at high pressures and treated with a drug-eluting balloon. Thirty-one lesions with undilatable stents were included at a single centre with experienced operators from March 2016 to February 2021. The mean number of prior procedures for in-stent restenosis was three and 14 lesions had multiple layers of stent. Procedural success (>50% increase in minimal stent diameter [MSD]) and adequate stent expansion (MSD >70% of reference vessel diameter) was achieved in all lesions. At six-month follow-up (N=26 lesions), there were six periprocedural myocardial infarctions due to slow flow, two cardiac deaths and one target lesion revascularisation. There were no perforations. Our niche experience at a centre with experienced operators demonstrated that ELCA led to larger final lumen and stent dimensions in highly selected patients with undilatable stents and recurrent restenosis at the cost of relatively frequent slow flow.

Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper

Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.

Excimer laser coronary atherectomy – An emerging tool in complex coronary lesions – A single centre experience

Excimer laser coronary atherectomy – An emerging tool in complex coronary lesions – A single centre experience

TCT-401 Initial Experience of a Single Referral Center Using Excimer Laser Coronary Atherectomy–Assisted Expansion in Undilatable Stents

TCT-401 Initial Experience of a Single Referral Center Using Excimer Laser Coronary Atherectomy–Assisted Expansion in Undilatable Stents

A risk predictive model for coronary perforation in patients undergoing percutaneous coronary intervention – APOLLO-XI score

Abstract Background Coronary perforation (CP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). Although several variables are associated with the risk of coronary perforation, a cumulative risk predictive model has not been established yet. Purpose To assess an incidence, risk factors and to develop risk predictive model for coronary perforation following PCI. Methods A single center, retrospective study of patients who underwent PCI from March 2010 to December 2019. Multivariate regression analysis was performed to identify independent predictors of CP. A risk predictive model was constructed with incremental weights attributed to each component variable according to their beta coefficients. Results 10,671 PCI procedures were enrolled. The incidence of CP was 0.94%. Adverse in-hospital outcomes were significant higher in CP group, including death (odds ratio [OR]: 3.58), mechanical circulatory support; including IABP and ECMO (OR: 3.79) and urgent revascularization (OR: 7.35). Multivariable analysis identified seven independent risk factors for CP, which were age (OR: 1.02), insulin-treated diabetes (OR: 2.50), prior CABG (OR: 2.03), hydrophilic guidewire (OR: 1.62), rotational atherectomy (OR: 2.60), excimer laser coronary atherectomy (ELCA) (OR: 3.39) and chronic total occlusion PCI (OR: 4.21). Risk predictive model (APOLLO-XI score) was calculated from the total points of each variables as follows: age (1 point per 10-year increase), hydrophilic guidewire (2 points), prior CABG (3 points), insulin-treated diabetes or rotational atherectomy (4 points), ELCA (5 points) and chronic total occlusion PCI (6 points). Cumulative risk score more than 11 points had increased risk for coronary perforation more than 1%. The validation of the risk predictive model (C-statistic) was 0.75 (95% CI: 0.70–0.80). Conclusions Coronary perforation is a rare but lethal complication. Our study demonstrates the risk predictive model which could enhance cardiovascular team to precisely estimate risk of coronary perforation before complex PCI procedure. Funding Acknowledgement Type of funding sources: None. Baseline charecteristicsAPOLLO-XI score

Impact of small diameter and low level of emission laser coronary atherectomy in patients with acute myocardial infarction

Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, β-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022–0.959, p = 0.045; OR, 0.077, 95% CI, 0.007–0.805, p = 0.032; OR, 6.494, 95% CI, 1.228–34.34, p = 0.028; OR, 0.890, 95% CI, 0.828–0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era.

The therapeutic effects of excimer laser coronary atherectomy therapy for in-stent restenosis chronic total occlusions

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.

Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry.

To assess the efficacy and safety of excimer laser coronary atherectomy (ELCA), as well as, the long-term outcomes and the factors associated with ELCA failure in uncrossable lesions. Uncrossable lesions constitute a challenge for percutaneous coronary intervention. This multicenter registry included 126 patients with 126 uncrossable lesions. Study endpoints were ELCA success, technical success and a composite of cardiac death, myocardial infarction (MI), and target-lesion revascularization (TLR) on follow-up. Predictors of ELCA failure were analyzed. Moderate or severe calcification was present in 79 (62.7%) of the lesions and 58 (46%) were a chronic total occlusion. ELCA success was obtained in 103 (81.8%) patients. Rotational atherectomy was attempted as bailout in 21 out of 23 ELCA failure (91.3%), being successful in 14 (66.7%) of them. Finally, technical and procedural success were achieved in 114 (90.5%) and 110 (87.3%) of the patients. Severe calcification was independently associated with ELCA failure (OR: 3.73, 95% CI: 1.35-10.32; p=.011). Two (1.6%) patients died (one after a stroke and another patient because of heart failure), 4 (3.2%) developed a non-Q MI without clinical consequences and 1 (0.8%) patient had a Q-MI. Other complications were ventricular tachycardia/fibrillation (n=2; 1.6%) and flow-limiting dissection (n=1, 0.8%). At follow-up (median 424 days), 3 (2.4%) patients died (1 (0.8%) from cardiovascular cause) and 15 (11.9%) required TLR. In our multicenter experience, ELCA use demonstrated to be safe and reasonably effective with a rate of events on follow-up relatively low. Severe calcification was associated with ELCA failure.