From Laser Physics to Clinical Utilization: Design and Ablative Properties of Cardiovascular Laser Catheters

Taylor, Kevin; Reiser, Christopher

doi:10.1007/978-1-4471-5220-0_1

“…Previous reports have shown ELCA to be feasible and efficient in primary PCI for STEMI, demonstrating improvement in TIMI flow, TIMI frame count, and TIMI myocardial blush grade [ 9 – 12 ]. The ELCA effect is based on three unique mechanisms of a pulsed xenon-chloride laser (photochemical, photothermal, and photomechanical), and its thrombus-vaporizing effect may exceed the simple mechanical effect of a manual aspiration catheter on reducing the thrombus burden [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have shown ELCA to be feasible and efficient in primary PCI for STEMI, demonstrating improvement in TIMI flow, TIMI frame count, and TIMI myocardial blush grade [9][10][11][12]. e ELCA effect is based on three unique mechanisms of a pulsed xenonchloride laser (photochemical, photothermal, and photomechanical), and its thrombus-vaporizing effect may exceed the simple mechanical effect of a manual aspiration catheter on reducing the thrombus burden [16]. e products of in vitro excimer laser thrombolysis are reported to be <10 micron in size [17], and previous clinical studies reported that ELCA achieved a higher rate of tissue-level reperfusion (myocardial blush grade, ST-segment resolution) than MT and balloon angioplasty in patients with STEMI [18,19].…”

Section: Discussionmentioning

confidence: 99%

Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Yamanaka

¹

,

Shimada

²

,

Tonomura

³

et al. 2021

Journal of Interventional Cardiology

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Objectives. We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background. Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods. A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results. The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT ( p < 0.0001 ) and 2.7 ± 0.5 after ELCA ( p = 0.0001 ). The median residual thrombus volume after MT was 65.7 mm3, which significantly reduced to 47.5 mm3 after ELCA ( p < 0.0001 ). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, p = 0.001 ). Significantly larger thrombus burden after MT (69.6 mm3 vs. 56.3 mm3, p < 0.05 ) and greater thrombus reduction by ELCA (21.2 mm3 vs. 11.8 mm3, p < 0.01 ) were observed in ruptured lesions than nonruptured lesions. Conclusions. ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.

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“…Last, the relatively lower utilization of laser atherectomy may result from its inability to debulk some heavily calcified lesions, slower plaque cutting rate, and the requirement of capital investment in a laser source. 8 Concomitant stenting was more common with laser atherectomy than with either orbital or excisional atherectomy. This higher rate of stenting could be attributed to the promising results seen in the SALVAGE study (Prospective, Multicenter Trial to Evaluate the safety to evaluate and performance of Spectranetics laser with adjunct PTA and GORE VIABHAN endoprosthesis for the treatment of SFA in Stent restenosis) that employed laser atherectomy and PTA followed by stenting, 22 and the CELLO registry (The CliRpath Excimer Laser System to enlarge lumen openings) that called for stenting if stenosis remained >30% after both laser activation and PTA.…”

Section: Discussionmentioning

confidence: 99%

“…Last, the relatively lower utilization of laser atherectomy may result from its inability to debulk some heavily calcified lesions, slower plaque cutting rate, and the requirement of capital investment in a laser source. 8…”

Section: Discussionmentioning

confidence: 99%

“…Laser ablation (photo-ablative) atherectomy employs a pulsed highenergy ultraviolet beam to vaporize the lesion without damaging the surrounding tissue. [6][7][8] Orbital or rotational atherectomy devices rotate an eccentrically-or concentrically-mounted, diamond-coated crown or tiny blades at high speeds to ablate calcified lesions through a sanding or cutting action with each pass of the device. 6 Excisional or directional atherectomy debulks the plaque as the device is advanced across the lesion through rotations of a carbide cutter disc that packs the excised plaque into a nose cone.…”

Section: Introductionmentioning

confidence: 99%

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Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization

Bai

¹

,

Fereydooni

²

,

Zhang

³

et al. 2021

J Endovasc Ther

7

0

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Purpose: The aim of this study is to analyze the utilization pattern of atherectomy modalities and compare their outcomes. Materials and Methods: All patients undergoing atherectomy in the 2010–2016 Vascular Quality Initiative Database were identified. Utilization of orbital, laser, or excisional atherectomy was obtained. Characteristics and outcomes of patients treated for isolated femoropopliteal and isolated tibial disease by different modalities were compared. Results: Atherectomy use increased from 10.3% to 18.3% of all peripheral interventions (n = 122 938). Orbital atherectomy was most commonly used and increased from 59.4% in 2010 to 63.2% of all atherectomies in 2016, while laser atherectomy decreased from 19.2% to 13.1%. Atherectomy was mostly used for treatment of isolated femoropopliteal disease (51.1%), followed by combined femoropopliteal and tibial disease (25.8%) and isolated tibial disease (11.7%). In isolated femoropopliteal revascularization, excisional atherectomy was associated with higher rate of perforation (1.2%) compared with laser (0.4%) and orbital atherectomy (0.5%). The technical success of orbital atherectomy (96.7%) was lower compared with excisional atherectomy (98.7%). Concomitant stenting was significantly higher with laser atherectomy (43.0%) compared with orbital (27.2%) and excisional (26.1%) atherectomy. Nevertheless, there was no difference in 1-year primary patency, reintervention, major amputation, improvement in ambulatory status, or mortality. Multivariable analysis also demonstrated no difference in 1-year primary patency and major ipsilateral amputation among the modalities. In isolated tibial revascularization, there were no differences in perioperative outcomes among the modalities. Excisional atherectomy was associated with the highest 1-year primary patency (88.1%). After adjusting for confounders, excisional atherectomy remained associated with superior 1-year primary patency compared with orbital atherectomy (odds ratio [OR] = 2.59, 95% confidence interval [CI] = [1.18–5.68]), and excisional atherectomy remained associated with a lower rate of 1-year major ipsilateral amputation compared with laser atherectomy (OR = 0.29, 95% CI = [0.09–0.95]). Conclusion: Atherectomy use has increased, driven primarily by orbital atherectomy. Despite significant variation in perioperative outcomes, there were no differences in 1-year outcomes among the different modalities when used for treating isolated femoropopliteal disease. In isolated tibial disease treatment, excisional atherectomy was associated with higher 1-year primary patency compared with orbital atherectomy and decreased major ipsilateral amputation rates compared with laser atherectomy. These differences warrant further investigation into the comparative effectiveness of atherectomy modalities in various vascular beds.

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Laser Revascularization in Coronary CTO

Topaz

2023

Chronic Total Occlusions

0

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From Laser Physics to Clinical Utilization: Design and Ablative Properties of Cardiovascular Laser Catheters

Cited by 3 publications

References 37 publications

Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Trends in Utilization and Outcomes of Orbital, Laser, and Excisional Atherectomy for Lower Extremity Revascularization

Laser Revascularization in Coronary CTO

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