Excimer laser coronary atherectomy prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions

Abstract

This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest-incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)-were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan-Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614-8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.

Usage of excimer laser in coronary and peripheral artery stenosis – analysis of its safety aspect

“…Released fragments (<10 μm in diameter) are absorbed by the reticuloendothelial system and do not occlude the smallest vessels [4]. Because of its properties, the laser reduces platelet aggregation and protects endothelial cells [2]. The catheter should be advanced slowly through the lesion in the artery (0.5 millimeters/second) to allow adequate absorption of light energy and efficient ablation.…”

“…The use of argon laser angioplasty was first performed in the context of salvaging an ischemic limb in 1983 [1,2]. Modern xenon laser's technology is based on ultraviolet energy and is capable of disintegrating atheroma without burning or gross fragmentation [3,4].…”

“…Initially, the successive development of coronary stents, with the simultaneous high costs of laser application, slowed down the development in catheter technology [1]. However, despite the proven effective use of stents in coronary artery disease (CAD), small vessel and ostial lesions make up the common difficulty with patient management [2]. ELCA has been useful in the case of balloon-resistant lesions to simplify stent expansion [2,7].…”

“…However, despite the proven effective use of stents in coronary artery disease (CAD), small vessel and ostial lesions make up the common difficulty with patient management [2]. ELCA has been useful in the case of balloon-resistant lesions to simplify stent expansion [2,7]. Furthermore, other basic indications for the use of an excimer laser including acute coronary syndrome, chronic total occlusion or under-expanded stents, thrombus,and in-stent restenosis highlight the wide range of ELCA use [2,8,9].…”

“…ELCA has been useful in the case of balloon-resistant lesions to simplify stent expansion [2,7]. Furthermore, other basic indications for the use of an excimer laser including acute coronary syndrome, chronic total occlusion or under-expanded stents, thrombus,and in-stent restenosis highlight the wide range of ELCA use [2,8,9].…”