Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Abstract

Introduction Excimer laser coronary atherectomy (ELCA) is a recognized adjunctive therapy utilized in the percutaneous management of complex coronary lesions. Studies examining its safety and utility have been limited by small sample sizes. Our study examines the determinants and outcomes of ELCA. Methods Using the British Cardiac Intervention Society database, data were analyzed on all PCI procedures in the UK between 2006–2016. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural and outcome associations with ELCA. Results We identified 1,471 (0.21%) ELCA cases out of 686,358 PCI procedures. Baseline covariates associated with ELCA use were age, BMI, number of lesions, CTO or restenosis attempted and history of prior MI, CABG or PCI. Procedural co‐variates associated with ELCA were the use of glycoprotein inhibitors, intravascular imaging, rotational atherectomy, cutting balloons, microcatheters and intra‐aortic balloon pumps. Adjusted rates of in‐hospital major adverse cardiac/cerebrovascular events (MACCE) or its individual components (death, peri‐procedural MI, stroke and major bleed) were not significantly altered by the use of ELCA. However, there were higher odds of dissection (OR 1.52, 95% CI 1.17–1.98), perforation (OR 2.18, 95% CI 1.44–3.30), slow flow (OR: 1.67, 95% CI 1.18–2.36), reintervention (OR: 2.12, 95% CI 1.14–3.93) and arterial complications (OR: 1.63, 95% CI 1.21–2.21). Conclusions ELCA use during complex PCI is associated with higher risk baseline and procedural characteristics. Although increased rates of acute procedural complications were observed, ELCA does not increase likelihood of in‐hospital MACCE or its individual components.

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

“…The rate of RASER use showed an initial increase in 2006–2013 followed by a plateau. This echoes the pattern seen with ELCA use from the same dataset 3 and likely represents the natural history of operators gaining more expertise and confidence in using ELCA and RASER in the earlier years. The subsequent drop in RASER use after 2014 may relate to the development of lower profile balloons and stents, extension catheters, and improved techniques to improve lesion crossing 13‐15 .…”

“…The RASER combination of atherectomy devices has been described in the literature since 2010 for the management of calcified coronary disease 2 . This coincided with the increasing uptake and experience gained with the use of ELCA 3,4 . Subsequent case reports and small series of its use in the literature have suggested reasonable efficacy and safety in complex calcified coronary disease including chronic total occlusions (CTO) 2,5‐8 .…”

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

“…Excimer Laser coronary atherectomy technology has improved significantly in recent years, and has become an important adjunctive tool for treating complex CAD, including ISR, yet it is not the reality of many centers worldwide due to lack of operators' training and device costs. 4 The present case demonstrates the importance of this technology, in a patient with multiple interventions and failures, including restenosis of several prior DES, likely attributed to bulky calcification and severe stent underexpansion. Excimer Laser coronary atherectomy was a precise option in this case, since its mechanisms of action allow reaching atherosclerotic plaques beyond the stent, not disrupting its metal architecture.…”

“…For instance, some studies from 1990´s showed 13 to 23% rates of dissection and 1 to 3% of perforation with the previous systems. Nowadays, these complications rates have been significantly reduced, and Protty et al 4 showed rates of dissection and perforation of 4.1 and 1.7%, respectively, without an increase of inhospital death. 4,7 In addition to improvement in device technology, saline injection methodology and lower loads of energy administered were essential to reduce the complication rates.…”

The Impact of Intracoronary Imaging on PCI Outcomes in Cases Utilising Rotational Atherectomy: An Analysis of 8,417 Rotational Atherectomy Cases from the British Cardiovascular Intervention Society Database

“…Study Design, Setting, and Participants. We retrospectively analysed national data from all patients undergoing RA-PCI in the United Kingdom between January 2007 and December 2014, as described previously [11]. During the study period, a total of 8,417 cases underwent RA-PCI and were eligible for inclusion (see Supplementary Figure S1).…”