Laser vaporization of atherothrombotic burden before drug‐coated balloon application in ST‐segment elevation myocardial infarction: Two‐year outcomes of the laser‐DCB trial

Abstract

Objectives This study aimed to examine whether the combination of excimer laser coronary atherectomy (ELCA) and drug‐coated balloon (DCB) angioplasty can provide feasible clinical outcome in patients with ST‐segment elevation myocardial infarction (STEMI) with 8‐month and 2‐year scheduled follow‐up angiography. Background Intracoronary thrombus elevates the risk of interventional treatment in patients with STEMI and hampers drug absorption into the vasculature released from DCB. Methods Sixty‐two patients with STEMI within 24 h after the onset of symptoms were enrolled in this prospective, single‐center, single‐arm study. Results The laser catheter was successfully crossed distal to the culprit lesion in all cases. No ELCA‐related adverse events occurred. Bail‐out stenting was required in two patients (3.2%) after adjunctive ballooning; thus, the remaining 60 patients were completed with DCB angioplasty without stenting. Scheduled angiography at 8 months and 2 years was completed in 100% and 85.2%, respectively, and minimal lumen diameters were 3.4 ± 0.5, 3.4 ± 0.6, and 3.4 ± 0.5 mm after the procedure, at 8 months and at 2 years, respectively. Binary restenosis was observed in five patients (8.1%) in whom target lesion revascularization was performed. The duration of dual antiplatelet therapy was 2.3 ± 2.2 months, and neither abrupt vessel closure, reinfarction, cardiac death nor major bleeding was observed. Conclusion A combination of DCB angioplasty with ELCA is a feasible therapeutic option for STEMI.

Contrast‐enhanced excimer laser stepwise approach during PCI for resistant coronary lesions

“…The ELCA is also effective in the vaporization of atherothrombotic lesions: Tonomura et al 18 demonstrated in a singlecentre prospective registry of 62 patients the feasibility of this device in ST-segment elevation followed by a DCB-alone strategy with a full success rate and late lumen expansion at 24 months follow-up in 19 patients (37.3%) with no adverse events.…”

“…13 Thus, similar to other registries, high procedural and technical success rates have been achieved in a large proportion of de novo RCL. [14][15][16][17][18] with no complications, suggesting an incremental strategy with the use of saline media in the setting of RCL. 14 In 2018, the LAVA observational registry, which includes 116 patients with RCL and a prevalence of severe calcification (62%), shows a high overall success rate (procedural success rate 88.8%) and a low MACE rate (3.45%).…”

Intraplaque wiring enables drug‐coated balloons to be utilized for percutaneous recanalization of chronically occluded coronary arteries

“…Dilatation of the cutting/ scoring balloon was performed incrementally as previously described. 14,15 Rotablation (Rotalink; Boston Scientific) or laser ablation (ELCA Coronary Laser Atherectomy Catheter, Royal Philips) was performed ahead of the balloon angioplasty when necessary. The size of the ablation catheter, rotational speed, maximum fluency, and the number of passes were left to the operator's discretion.…”

“…The diameter of the cutting/scoring balloon was selected to a balloon‐to‐reference vessel diameter ratio of approximately 1.0–1.2 but not exceeding the IVUS‐measured vessel diameter at the diseased segment. Dilatation of the cutting/scoring balloon was performed incrementally as previously described 14,15 . Rotablation (Rotalink; Boston Scientific) or laser ablation (ELCA Coronary Laser Atherectomy Catheter, Royal Philips) was performed ahead of the balloon angioplasty when necessary.…”

Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu’s arteritis: a case report and review of the literature

“…PCIs include metallic stent implantation and balloon dilatation, but in-stent restenosis (ISR) frequently occurs in metallic stent implantation. For ISR management, drug-eluting stents (DES), drug-coated balloons (DCB), and excimer laser coronary atherectomy (ELCA) are currently used [ 7 ]. Only a few studies are currently evaluating DES/DCB for treating patients with TAK and CA involvements, and the effectiveness is unclear.…”