Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital

Abstract

BackgroundExcimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the smaller 0.9 mm laser catheter. As the coronary complexity has increased, there has been a renewed interest in the ELCA. This study investigates the indications, procedural characteristics, complications and outcomes of ELCA in a contemporary coronary interventional practice.MethodsThis single-centre study retrospectively analysed 50 patients treated with ELCA between January 2013 and January 2019.ResultsPatients had a mean age of 67.9±11.4 years with a male predominance (65.3%). 25 (50%) cases were performed in patients with stable angina. Failure to deliver the smallest available balloon/microcatheter was the most frequent indication in 32 (64%) cases for ELCA use. 30 (60%) of the procedures were performed via radial access. The 0.9 mm X-80 catheter was used in 41 (82%) of cases, delivering on average 9000±3929 pulses. ELCA-related complications included 2 coronary dissections and 1 perforation, all of which were covered with stents. No major complications could be directly attributed to the use of ELCA. There was one death and one case of stent thrombosis within 30 days of the procedure.ConclusionELCA can be performed safely via the radial approach with a 0.9 mm catheter with a high success rate by suitably trained operators. The low procedure-related complications with contemporary techniques make this a very useful tool for complex coronary interventions, especially for difficult to dilate lesions and chronic total occlusion vessels.

An analysis of long‐term clinical outcome following the use of excimer laser coronary atherectomy in a large UK PCI center

“…Similar to previous studies our analysis showed that the most common indication for ELCA PCI use was calcific/uncrossable lesions and as such the most frequently used catheter is the 0.9 mm device given this is highly deliverable with option for high fluence and frequency of energy delivered to achieve modulation of the lesion. 2,10 ELCA PCI for thrombus indication is an effective and safe technique but remained at a low level during our study timeframe largely because of the absence of prospective clinical data to support use in these patients. Interestingly, in a small study comparing manual thrombus aspiration and ELCA in patients with STEMI, Shimojo et al demonstrated that ELCA PCI was associated with a reduced creatine kinase and improved LV function.…”

“…There have been several retrospective cohorts and case series that have demonstrated the short-term efficacy of ELCA. [8][9][10][11][12][13][14][15] The largest study to date is based on the National Cardiovascular Data Registry (NCDR) which demonstrated that the use of ELCA PCI was associated with a higher frequency of periprocedural complication. 14 Similarly, the British Cardiovascular Intervention Society (BCIS) database (from 2010 to 2016) demonstrated an increased risk of periprocedural complications but not major short-term adverse cardiac/cerebrovascular events with the use of ELCA.…”

“…The lack of broad availability of ELCA has probably contributed to the absence of contemporary data regarding the efficacy of this technique, particularly with reference to the long‐term outcomes. There have been several retrospective cohorts and case series that have demonstrated the short‐term efficacy of ELCA 8–15 . The largest study to date is based on the National Cardiovascular Data Registry (NCDR) which demonstrated that the use of ELCA PCI was associated with a higher frequency of periprocedural complication 14 .…”