Application of Excimer Laser Coronary Angioplasty (ELCA) in Bifurcation Lesions

Abstract

Excimer laser coronary angioplasty (ELCA) offers a unique approach to the treatment of bifurcation lesions that continues to present a challenge in percutaneous coronary intervention. Debulking plaque prior to stenting or balloon angioplasty has demonstrated significant improvement in the treatment of bifurcation lesions. Clot dissipation properties of excimer laser combined with its ability to debulk, makes this device unique when applied to thrombus-laden bifurcation lesions. ELCA is the only debulking technique that allows retention of two guide wires with resultant protection of the bifurcation vessels during the debulking procedure. We herein describe three patients with unstable angina who underwent a debulking procedure with ELCA involving application of single and double wire techniques. These three cases illustrate two different techniques used for debulking bifurcation lesions. Both single and double wire techniques are described. ELCA can be used safely and effectively in high-risk patients with bifurcation lesions, even in the presence of thrombus.

A Complex Case of Angulated and Bifurcated Lesion Facilitated by Excimer Laser Coronary Angioplasty

“…Although debulking should avoid plaque shift and other complications in the side branch, having another wire in the side branch may be useful if, for example, a dissection propagates from the main to the side branch. Of note, in our case, ELCA use enabled debulking of the proximal lesion without causing plaque shift into the LAD, and its subsequent occlusion, which would have been likely to occur if balloon dilatation only had been performed 11 . At that point, a BMW wire was easily advanced into the angulated lesion because less friction was present, thus allowing better wire manipulation.…”