Current interventional coronary applications of excimer laser

Abstract

Excimer laser utilization as an adjunctive device for percutaneous coronary intervention has increased in the last few years. Many technical advancements have led to better results in terms of efficacy and safety with a low complication rate. In particular, excimer laser for thrombus-containing lesions is able to achieve rapid thrombus removal and plaque debulking along with subsequent facilitation of stent angioplasty and a low rate of microvascular obstruction. Other indications for laser angioplasty embrace in-stent restenosis, chronic total occlusions, saphenous vein graft lesions and new potential applications, such as stent expansion optimization and bifurcation lesions. As for other medical devices, however, excimer laser should be tested in future randomized studies against current standard of therapy in order to better define its role for each of the indications summarized above.

Comparison of percutaneous coronary intervention of native coronary artery versus bypass graft in patients with prior coronary artery bypass grafting

“…With the improvement of ELCA and operator techniques, ELCA has been increasingly used for SVG intervention ( 28 ). It is able to vaporize the thrombus, reducing the risk of distal embolization ( 29 ).…”

Thrombus Embolisation: Prevention is Better than Cure

“…Excimer laser coronary atherectomy (ELCA) is potentially effective in reducing the size of coronary thrombus by inducing shock waves that can separate thrombus from the vessel wall, dissolve clot by acoustic waves within the thrombus structure and vaporise pro-coagulant mediators. [58,59] Laser also has an inhibitory effect on platelet aggregation due to interaction with the 308-nm ultraviolet beam leading to ‘stunned platelet phenomenon’. [60] Despite the theoretical potential, there are limited data to support its use in primary PCI.…”

Late Presenting ST Elevation Myocardial Infarction Managed with Adjunctive Laser Therapy

“…Now that thrombus aspiration has evaporated from routine use in the primary PCI setting, the Excimer laser could be useful as it can dissipate thrombus, vaporize pro-coagulant mediators, and may suppress platelet aggregation [1]. Laser therapy also has a debulking effect on plaque and may reduce distal embolization, microvascular dysfunction and facilitate stent deployment [2]. The technology has been around for over two decades and its use has been explored in acute coronary syndromes, in-stent restenosis, chronic total occlusions and calcified lesions, but its uptake has been poor, partly due to the increase cost associated with its use, and evidence base mainly limited to registry data [3][4][5][6].…”