The state of the excimer laser for coronary intervention in the drug-eluting stent era

Badr, Salem; Ben‐Dor, Itsik; Dvir, Danny; Barbash, Israel M.; Kitabata, Hironori; Minha, Sa’ar; Pendyala, Lakshmana; Loh, Joshua P.; Torguson, Rebecca; Pichard, Augusto D.; Waksman, Ron

doi:10.1016/j.carrev.2012.12.008

Cited by 64 publications

(30 citation statements)

References 19 publications

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“…[7][8][9] In recent years, laser atherectomy has been gaining back space, especially in the management of lesions requiring appropriate ablation, such as cases of in-stent restenosis and chronic coronary occlusion. 2,4 Several factors contributed to this resumption of the use of laser atherectomy, primarily: 3 the great technological evolution of devices and catheters for laser application, both in terms of type of laser (currently the Excimer Laser), and the smaller size and better features of delivery devices, which enable addressing previously inaccessible lesions; laser being no longer used as an isolated targeted therapy, but rather as an adjuvant therapy to more modern devices, with lower restenosis rates; better knowledge of the mechanisms and properties of laser atherectomy, which led to its use in lesions requiring appropriate intimal resection, such as in-stent restenosis and chronic coronary occlusion.…”

Section: Discussionmentioning

confidence: 99%

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

Dallan¹,

Pereira²,

Bezerra³

2019

J Transcat Intervent

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We describe the case of a patient with multiple comorbidities scheduled to undergo intracoronary optical coherence tomography-guided percutaneous coronary intervention. Based on the images acquired, it was possible to observe the mechanism of restenosis and the anatomy of the lesion, and to optimize planning of the procedure. Our strategy was to resect the neointimal hyperplastic tissue using laser atherectomy, with great results and a successful procedure.RESUMO -Descrevemos o caso de um paciente com múltiplas comorbidades, que seria submetido à intervenção coronária percutânea guiada por tomografia de coerência óptica intracoronariana e, de acordo com as imagens obtidas, pudemos observar o mecanismo de reestenose, a anatomia da lesão e o planejamento do procedimento de forma otimizada. Optamos por estratégia de ressecção tecidual de hiperplasia neointimal com aterectomia a laser, com ótimo resultado e sucesso do procedimento.

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Section: Discussionmentioning

confidence: 99%

“…1 It is an effective form of atherectomy for complex coronary lesions, 2,3 and has been gaining space in the management of lesions that require appropriate ablation, like in-stent restenosis and chronic coronary occlusions. 2,4 We describe a case of a PCI guided by intracoronary optical coherence tomography (OCT), using laser atherectomy.…”

Section: Introductionmentioning

confidence: 99%

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

Dallan¹,

Pereira²,

Bezerra³

2019

J Transcat Intervent

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“…7) ELCA has been shown to be both safe and effective for plaque modification in severely calcified plaques and chronic total occlusions, in which balloons have failed to cross or expand the lesions. 27) ELCA has been previously reported to facilitate stent expansion in balloon-resistant lesions.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Clinical Outcomes after Treatment with Excimer Laser Coronary Atherectomy for In-Stent Restenosis of Drug-Eluting Stent

et al. 2018

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SummaryExcimer laser coronary atherectomy (ELCA) has been used for the treatment of complex percutaneous coronary intervention (PCI) such as in-stent restenosis (ISR). However, little information was provided about the clinical outcomes after treatment with ELCA for ISR of drug-eluting stents (DES). This study aimed to investigate the long-term clinical outcomes after PCI with ELCA for ISR of DES. A total of 81 consecutive patients with 87 lesions who underwent PCI for ISR of DES were included. Patients were classified into a PCI with ELCA group (23 patients with 24 lesions) and a PCI without ELCA group (58 patients with 63 lesions). The major adverse cardiac events (MACE) were evaluated. The mean duration of clinical follow-up was 29.8 ± 11.6 months. The incidences of diffuse restenosis and AHA/ACC type B2 or C lesion in the PCI with ELCA group were higher than in the PCI without ELCA group. Quantitative coronary angiography showed the acute luminal gain in the PCI with ELCA group was greater than in the PCI without ELCA group (1.64 ± 0.48 mm versus 1.26 ± 0.42 mm, P < 0.001). There were no significant differences in all-cause death, myocardial infarction, or target lesion revascularization between the 2 groups. Multivariate analysis due to a Cox proportionalhazards model showed that multivessel disease was an independent predictor of MACE (hazard ratio 3.05, 95% confidence interval 1.22 to 7.61, P = 0.02). ELCA was effective as an atherectomy device for lumen enlargement and optimal lesion preparation. Even though ELCA was used for ISR of DES in significantly more complex lesions, the long-term clinical outcomes were favorable and similar.(Int Heart J 2018; 59: 14-20) Key words: Complex percutaneous coronary intervention, Atherectomy device, Revascularization D rug-eluting stents (DES) dramatically reduced the rate of in-stent restenosis (ISR) compared to bare-metal stents in a randomized trial. 1) Moreover, the clinical outcomes have further improved with the advent of second-generation DES.2) However, with the increasing use of DES and the frequent implantation of a DES into complex lesions, ISR has become a challenging problem in percutaneous coronary intervention (PCI).3) Editorial p.1Excimer laser coronary atherectomy (ELCA) has been effective for PCI of complex lesions, including stent restenosis, calcified lesions, chronic total occlusion, and ostial and long lesions. 4) ELCA has been useful to facilitate stent expansion in balloon-resistant lesions. 5) However, there is little information about the clinical outcomes after treatment with ELCA for ISR. Thus, the present study evaluated the long-term clinical outcomes after PCI with ELCA for ISR of DES. Methods Patients:Between January 2012 and March 2015, a total of 913 consecutive patients with 1024 lesions underwent PCI at the Department of Invasive Cardiology, Englewood Hospital and Medical Center. Of these, 81 consecutive patients (8.9%) with 87 lesions (8.5%) who underwent PCI for ISR of DES were included in this study. According to the use of ELCA,...

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“…Globally, both have increased over the past two decades, reflecting the technical improvements of the device and a learning-curve effect. Badr, et al 3) recently published their experience with ELCA in different clinical settings (n = 119 patients, 124 lesions). In the CTO group (n = 32), the ELCA success rate was 93.8% and the angiographic success rate was 90.6%.…”

Section: Discussionmentioning

confidence: 99%

“…1) ELCA has been shown to be both safe and effective for plaque modification in severely calcified plaques and CTO, in which balloons have failed to cross or expand the lesion. 2,3) However, when tested against balloon angioplasty, stenting and rotational atherectomy (RA), ELCA failed to show superiority for efficacy and safety. 4,5) Subsequently, especially after the introduction of drug-eluting stents (DES), use of ELCA has become quite limited.…”

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confidence: 99%

Laser Atherectomy for Balloon Failure in Chronic Total Occlusion

Azzalini

2014

Int. Heart J.

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SummaryExcimer laser coronary atherectomy (ELCA) is based on ultraviolet energy and is capable of disintegrating atheroma, without burning or grossly fragmenting it. ELCA has proven effective in the percutaneous treatment of a variety of complex lesions, including chronic total occlusions (CTO) and severely calcified lesions, in case of balloon failure-tocross or failure-to-expand. Here we present a case of a successful CTO recanalization with ELCA after balloon failure, review the literature on this topic, and present an algorithm outlining the management of this challenging clinical scenario. (Int Heart J 2014; 55: 546-549) Key words: Laser-assisted angioplasty, Coronary occlusion, Percutaneous coronary intervention E xcimer laser coronary atherectomy (ELCA) has been proven to be effective for the percutaneous treatment of a variety of complex lesions, including chronic total occlusions (CTO) and severely calcified lesions when conventional ballooning techniques have failed, stent restenosis, saphenous vein graft debulking, and thrombus vaporization in acute coronary syndromes. 1)ELCA has been shown to be both safe and effective for plaque modification in severely calcified plaques and CTO, in which balloons have failed to cross or expand the lesion. 2,3)However, when tested against balloon angioplasty, stenting and rotational atherectomy (RA), ELCA failed to show superiority for efficacy and safety. 4,5) Subsequently, especially after the introduction of drug-eluting stents (DES), use of ELCA has become quite limited. Nevertheless, in well-defined clinical settings ELCA still represents a valid -and sometimes the only -alternative. Here, we present the case of a successful CTO recanalization with ELCA, after failure to cross with multiple coronary devices. Case ReportA 34-year-old man presented to a referring hospital's emergency room with multiple episodes of prolonged chest pain at rest. His prior medical history included heterozygosis for Factor V Leiden mutation with documented pulmonary embolism 4 years earlier. He also had an important family history of premature coronary artery disease (CAD). After screening tests ruled out pulmonary embolism and despite a lack of dynamic EKG changes, a diagnosis of non-ST elevation myocardial infarction motivated the decision to refer the patient for cardiac catheterization. Prior to transfer to our institution, aspirin and clopidogrel were preloaded. Coronary angiography showed left dominance and two-vessel disease ( Figure 1): a thrombotic, 85%, type B2, bifurcation lesion in the proximal circumflex (Medina 1, 0, 1), followed by a 60%, diffuse, type C lesion in the mid circumflex; and a CTO of the mid left anterior descending (LAD) artery, which received Werner collateral connections grade 2 from the right coronary artery (RCA) and circumflex artery, through septal and epicardial vessels. Thrombectomy in the circumflex was performed. Balloon dilatation was followed by the implantation of two Integrity TM (Medtronic Inc., Minneapolis, MN) bare-metal stents (a 3.0 ...

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The state of the excimer laser for coronary intervention in the drug-eluting stent era

Cited by 64 publications

References 19 publications

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

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

Long-Term Clinical Outcomes after Treatment with Excimer Laser Coronary Atherectomy for In-Stent Restenosis of Drug-Eluting Stent

Laser Atherectomy for Balloon Failure in Chronic Total Occlusion

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