Combined use of rotational and excimer lASER coronary atherectomy (RASER) during complex coronary angioplasty—An analysis of cases (2006–2016) from the British Cardiovascular Intervention Society database

Abstract

Introduction Combining rotational (RA) and excimer laser coronary atherectomy (ELCA)—RASER atherectomy—is technique utilized in the percutaneous management of calcific coronary disease. The evidence base examining its safety and utility is sparse and limited to small case‐series. This study examines the patterns and outcomes of RASER atherectomy use in the largest cohort to date. Methods Using the British Cardiac Intervention Society database, data were analyzed on all PCI procedures in the UK between 2006 and 2016. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural, and outcome associations with RASER. Results We identified 153 (0.02%) RASER atherectomy cases out of 686,358 PCI procedures. Baseline covariates associated with RASER use were age, BMI, diabetes, stable coronary disease, and previous CABG. Procedural co‐variates associated with RASER were CTO‐PCI, the use of more/longer stents, intravascular imaging, cutting balloons, and microcatheters. Adjusted rates of in‐hospital major adverse cardiac/cerebrovascular events (MACCE) were not significantly different with RASER. However, there were higher odds of arterial complications (OR 3.23, 95% CI: 1.58–6.61), slow flow (OR 3.50, 95% CI: 1.29–9.55), and shock induction (OR 9.66, 95% CI: 3.44–27.06). Conclusions RASER atherectomy use in complex PCI is associated with higher risk baseline and procedural characteristics. Although increased rates of shock induction, slow flow, and arterial complications were observed, RASER does not increase the likelihood of in‐hospital MACCE, major bleeding, or death.

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

“…Danek et al [ 22 ], in a study based on data from the PROGRESS-CTO registry, the rate of coronary perforation was much higher when ELCA was used than when it was not (7% vs. 2%, respectively; p < 0.009). Protty et al [ 23 ] also reported that ELCA was associated with a higher coronary perforation rate (odds ratio: 2.18, 95% confidence interval: 1.44–3.30) based on data from the British Cardiovascular Intervention Society database. For ISR CTO procedures, the wires may not remain in the true lumen as they are advanced in some segments; therefore, ELCA requires experienced operators, and operators must be cautious to avoid this kind of serious complication.…”

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

“…Further applications of ELCA include a combination technique that utilizes both RA and ELCA simultaneously for modification of heavily calcified lesions. This technique, termed RASER atherectomy, was introduced in 2012 24 and was recently examined in a large retrospective study using data from the British Cardiac Intervention Society database between 2006 and 2016 25 . Outcomes of the RASER technique were significant for a higher incidence of arterial complications (OR: 3.23, 95% CI: 1.58–6.61), slow flow (OR: 3.50, 95% CI: 1.29–9.55), and shock (OR: 9.66, 95% CI: 3.44–27.06), without an increase in the likelihood of major bleeding, major adverse cardiovascular and cerebrovascular events, or death 25 …”

“…25 Outcomes of the RASER technique were significant for a higher incidence of arterial complications (OR: 3.23, 95% CI: 1.58-6.61), slow flow (OR: 3.50, 95% CI: 1.29-9.55), and shock (OR: 9.66, 95% CI: 3.44-27.06), without an increase in the likelihood of major bleeding, major adverse cardiovascular and cerebrovascular events, or death. 25…”

Review on Laser Technology in Intravascular Imaging and Treatment

“…Although RA can be performed in the presence of severe calcification, it is contraindicated in AMI, while ELCA is highly useful in acute settings. Recently, ELCA combined with RA in severely calcified lesions has been described as “RASER” [ 132 , 133 ]. The clinical effect of excimer laser combined with traditional PCI, RA, and DCB is better than that of a single method.…”