Excimer Laser Coronary Angioplasty in Coronary Lesions: Use and Safety From the NCDR/CATH PCI Registry

Abstract

Background: Excimer laser coronary angioplasty (ELCA) uses a ultraviolet laser catheter for the treatment of coronary artery disease. ELCA has been used for various coronary lesions, but current safety and frequency of use are unknown. Methods: We performed a retrospective, registry-based study of ELCA use during coronary interventions reported to the National Cardiovascular Data Registry/CATH percutaneous coronary intervention registry from 2009 to 2018 (n=6 043 596 total interventions evaluated). The primary safety end point was the combination of any perforation, dissection, tamponade, or death. ELCA use per 10 000 interventions was evaluated for the study duration. Subgroups of interest were identified including in-stent restenosis lesions, saphenous vein graft lesions, chronic total occlusions, and thrombotic lesions. Results: A total of 19 688 lesions were identified with ELCA use (0.3% of all lesions). The rate of ELCA use increased across the study period from 14 ELCAs performed per 10 000 interventions in 2009 to 70 ELCAs performed per 10 000 interventions in 2018. The primary safety end point occurred in 4.2% of lesions and was higher than in cases where no ELCA was used (3.0% P <0.001). After adjusting for baseline differences among the subgroups who received ELCA, the in-stent restenosis group had the lowest rate of complications (odds ratio, 0.51 [95% CI, 0.42–0.63]), followed by the saphenous vein graft group (odds ratio, 0.72 [95% CI, 0.5–1]). The chronic total occlusion group had a higher risk for complications (odds ratio, 2.01 [95% CI, 1.61–2.40]). Conclusions: The use of ELCA has remained low but has increased in recent years. Complications are significantly higher when ELCA is used, but this effect is variable with respect to lesion subtype. ELCA is frequently used to treat in-stent restenosis with a low risk of complication. ELCA use during chronic total occlusion interventions is associated with a 2-fold increased risk of complications. Together these findings provide guidance for lesion selection to optimize safety with ELCA use.

A feasibility study on removing lipid deposition in atherosclerotic plaques with ultrasound-assisted laser ablation

“…The advantage of combining ultrasound with laser could be the reduced risk of complications as compared to the use of laser alone in ELCA. The usage of ELCA for atherosclerosis is low as compared to non-ELCA PCI due to the higher risk of complications such as dissection and perforation (Sintek et al 2021). The complications are partially due to strong vaporization and the uncontrolled forceful expansion of the vapor bubble and its collapse, resulting in shock waves (van Leeuwen Ton et al 1992).…”

“…In early clinical trials, the efficacy of ELCA was less or almost the same as balloon angioplasty, but it increased the risk of vessel dissection and perforation (Litvack et al 1994, Appelman et al 1996, Holmes et al 1997, Köster et al 2000. As a result, the overall use of ELCA remains low due to the higher risk of complications as compared with non-ELCA PCI procedures (Sintek et al 2021).…”

A review on photo-mediated ultrasound therapy

“…48 However, clinical use of ELCA is limited due to its less efficiency in plaque removal and higher chances of developing complications. 49 The limitations of ELCA may be overcome by combining ultrasound with laser-based treatment. The combined ultrasound and laser treatment were tested to remove the atherosclerotic plaque in a recent study.…”

Complications of PCI and its Management

“…[46] Excimer laser angioplasty Excimer laser is used in moderate calcific vessels, ISR lesions, balloon uncrossable and un dilatable lesions, CTO, ostial lesions, and SVG graft thrombus containing lesions. [47] e PELCA registry of 1521 patients had complications of dissection -22%, vasospasm -6.1%, perforation -2.4%, arrhythmia -0.7%, and aneurysm formation -0.3%. Death occurred in 0.7%.…”