Physical aspects of excimer laser angioplasty for undilatable lesions

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

“…Clinical trials from the same era, which enrolled a few hundred patients at most, showed no difference in major in‐hospital complications, defined as death, Q‐wave MI, or revascularisation (including CABG), but reported rates of severe dissection (clinically compromising) of 9–14% and 1.3% risk of perforation 28 . The evolution of interventional technology has significantly improved complication rates and outcomes and additional modification of the ELCA technique such as selective use of saline infusion (where appropriate) has also improved the safety profiles 8,29 . This is reflected by our findings of coronary dissection rates of 4.1% and coronary perforation rates of 1.7% with no increase in tamponade or emergency CABG rates, which are at stark contrast with historical noncontemporary data (Table S3).…”

Management of in-stent restenosis of the left main coronary artery with laser atherectomy guided by intracoronary optical coherence tomography

“…The diameter of fragments released is <10μm, and they are absorbed by the reticuloendothelial system, which prevents microvascular obstruction. 10 The safety and efficacy of the ELCA are well established, particularly for management of complex lesions requiring appropriate neointimal resection. [1][2][3][4] However, since the use of this technique is restricted in our country, due to the high cost of atherectomy devices in general, as well as to the lack of knowledge about new pieces of equipment and favorable outcomes of the current technique, national data regarding its use are still scarce.…”

Excimer Laser LEsion Modification to Expand Non-dilatable sTents: The ELLEMENT Registry

“…Absorption of excimer laser by tissue may lead to photochemical, photomechanical, or photothermal interactions but the predominant effect of ELCA involves a thermomechanical process of rapidly expanding and imploding vapor bubbles [9,[16][17][18][19][20]. The rapid conversion of water to water vapor produces an explosive increase in volume and generates acoustic shock waves up to tens of kbars that propagate away from the irradiated tissue [9,19].…”

“…This also highlights the most important caveat of this technique, that contrastenhanced ELCA should only be performed within the stent to minimize the risk of vessel injury. Secondly, we recommend that only smaller laser catheters such as the 0.9 mm be used for this technique as the vapor bubbles generated during ELCA are three times greater than the diameter of the laser catheter [9]. Thus, the use of larger size laser catheters in a blood or contrast medium can result in macro-bubble formation (Fig.…”

“…Implantation of another stent within an underexpanded stent is unlikely to correct the problem and will probably worsen what is primarily a mechanical problem, leading to recurrent restenosis or ST. Excimer laser coronary angioplasty (ELCA) has been previously reported to facilitate stent expansion in balloon-resistant lesions [6][7][8][9][10]. It has been noted that the impact of ELCA on the surrounding tissue is dependent on the Cardiovascular Revascularization Medicine 15 (2014) [8][9][10][11][12] ✩ There are no potential conflicts of interest or funding sources to disclose.association with contrast media, saline and blood [11]. In previous studies, the technique of saline "flush and bathe" was used in order to reduce the risk of coronary dissection induced by high-pressure waves [7,12].…”