Excimer Laser in Percutaneous Coronary Intervention of Device Uncrossable Chronic Total and Functional Occlusions

Mohandes, Mohsen; Rojas, Sergio; Moreno, Cristina; Fernández, Francisco; Fuertes, Mónica; Guarinos, Jordi

doi:10.1016/j.carrev.2019.08.022

Cited by 13 publications

(11 citation statements)

References 9 publications

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“…Minor complications were observed in one case in each group (patients with failure of balloon to cross and failure of balloon expansion in the context of CTO), but not due to use of the laser [23]. Similar data was presented by Mohandes et al in a study of six patients with chronic total (100%) and functional occlusion, successful dilatation using excimer laser were achieved in five of the six patients (83.3%) [24].…”

Section: Description Of the State Of Knowledgesupporting

confidence: 82%

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

Machowiec¹,

Ręka²,

Piecewicz‐Szczęsna³

2020

J Pre Clin Clin Res.

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Introduction. The technology of laser atherectomy has been known for about 20 years. Initial studies were not encouraging due to similar or lower efficacy compared to conventional angioplasty and greater complication rate. The introduction of new, low-profile catheters with high parameters of transmitted energy, a change in the procedure for performing angioplasty and the proper qualification of the lesions resulted in a reduction of adverse effects. Objective. The aim of the study was to present the current state of knowledge regarding the usage of excimer laser in coronary and peripheral arteries stenosis, its indications and contraindications as well as safety aspect. The article reviews 32 recent publications available on the PubMed and Google Scholar databases. Abbreviated description of the state of knowledge. The excimer laser emits ultraviolet energy and ablates the tissue in a vessel. The main indications for the use of the laser include: restenosis in the stent, ostial lesions, long, calcified lesions >20 mm and moderately and severely calcified lesions. There are isolated reports describing the use of ELCA in the treatment of acute coronary syndromes. Excimer laser also can be applied in a treatment of stenosis of peripheral arteries. Conclusion.Excimer laser coronary atherectomy is a safe and feasible technique for the treatment of ISR and is associated with a relatively low recurrent restenosis compared to scoring balloon dilatation alone. It is a very important and safe alternative to classic treatment methods, but further research assessing the usefulness of this procedure is required.

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Section: Description Of the State Of Knowledgesupporting

confidence: 82%

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

Machowiec¹,

Ręka²,

Piecewicz‐Szczęsna³

2020

J Pre Clin Clin Res.

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“…ELCA works by producing monochromatic light energy to cause heat and shock waves that lead to disruption of plaque and thrombus. The indications for its use include optimisation of under‐expanded stents, 1 reduction in myocardial infarction (MI) related thrombus burden, 2 prestent treatment of degenerative saphenous vein grafts, 3 chronic total occlusions (CTO) 4 and noncrossable or nondilatable lesions 5 …”

Section: Introductionmentioning

confidence: 99%

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

Protty

Hussain

Gallagher

et al. 2020

Cathet Cardio Intervent

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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.

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“…Laser atherectomy has several niche indications, including balloon uncrossable or undilatable lesions, chronic total occlusions, debulking vein graft disease, and treating calcific non-dilatable ISR [ 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ]. The Laser Veterans Affairs (LAVA) Multicenter Registry evaluated the use of ELCA in 130 target complex coronary lesions performed between 2008 and 2016 [ 92 ].…”

Section: Modalities For Coronary Calcium Modificationmentioning

confidence: 99%

Contemporary Management of Severely Calcified Coronary Lesions

Angsubhakorn

Kang

Fearon

et al. 2022

JPM

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Coronary artery calcification is increasingly prevalent in our patient population. It significantly limits the procedural success of percutaneous coronary intervention and is associated with a higher risk of adverse cardiovascular events both in the short-term and long-term. There are several modalities for modifying calcified plaque, such as balloon angioplasty (including specialty balloons), coronary atheroablative therapy (rotational, orbital, and laser atherectomy), and intravascular lithotripsy. We discuss each modality’s relative advantages and disadvantages and the data supporting their use. This review also highlights the importance of intravascular imaging to characterize coronary calcification and presents an algorithm to tailor the calcium modification therapy based on specific coronary lesion characteristics.

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Excimer Laser in Percutaneous Coronary Intervention of Device Uncrossable Chronic Total and Functional Occlusions

Cited by 13 publications

References 9 publications

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

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

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

Contemporary Management of Severely Calcified Coronary Lesions

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