Case-Control Registry of Excimer Laser Coronary Angioplasty Versus Distal Protection Devices in Patients With Acute Coronary Syndromes due to Saphenous Vein Graft Disease

Niccoli, Giampaolo; Belloni, Flavia; Cosentino, Nicola; Fracassi, Francesco; Falcioni, Elena; Roberto, Marco; Panico, Roberta Antonazzo; Mongiardo, Rocco; Porto, Italo; Leone, Antonio Maria; Burzotta, Francesco; Trani, Carlo; Crea, Filippo

doi:10.1016/j.amjcard.2013.07.015

Cited by 26 publications

(7 citation statements)

References 30 publications

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“…By contrast, platelet glycoprotein IIb/IIIa receptor inhibitors can cause harm during SVG intervention and should not be used routinely in SVG PCI (32). Laser may result in "vaporization" of thrombus and plaque components, potentially reducing the risk for distal embolization; however, it may lead to perforation, especially in highly angulated SVGs (33).…”

Section: A B B R E V I a T I Omentioning

confidence: 99%

Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery

Xenogiannis

Tajti

Hall

et al. 2019

JACC: Cardiovascular Interventions

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Section: A B B R E V I a T I Omentioning

confidence: 99%

Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery

Xenogiannis

Tajti

Hall

et al. 2019

JACC: Cardiovascular Interventions

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“…In addition, relatively more simple techniques have also been adopted to prevent distal embolization, including direct stenting and excimer laser atherectomy. 38,39 In Japan, PCI for AG is 23% of all graft PCIs, which is higher than in other countries. We sometimes performed PCI for AG because of the intimal thickening at the anastomosed part of the AG.…”

Section: Resultsmentioning

confidence: 99%

“…The anatomic difficulties of SVG lesions, higher procedural costs, and longer procedural times may also contribute to the lower rate of EPD use during PCI for SVG. In addition, relatively more simple techniques have also been adopted to prevent distal embolization, including direct stenting and excimer laser atherectomy 38,39 …”

Section: Discussionmentioning

confidence: 99%

In‐hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry

Oba

Inohara

Takahashi

et al. 2021

Cathet Cardio Intervent

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Objectives: We evaluated the in-hospital outcomes of percutaneous coronary intervention (PCI) for bypass graft vessels (GV-PCI) compared with those of PCI for native vessels (NV-PCI) using data from the Japanese nationwide coronary intervention registry.Methods: We included PCI patients (N = 748,229) registered between January 2016 and December 2018 from 1,123 centers. We divided patients into three groups: GV-PCI (n = 2,745); NV-PCI with a prior coronary artery bypass graft (pCABG) (n = 23,932); and NV-PCI without pCABG (n = 721,552).Results: GV-PCI implementation was low, and most cases of PCI in pCABG patients were performed in native vessels (89.7%) in contemporary Japanese practice. The risk profile of patients with pCABG was higher than that of those without pCABG.Consequently, GV-PCI patients had a significantly higher in-hospital mortality than NV-PCI patients without pCABG after adjusting for covariates (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.66-3.36, p < .001). Of note, embolic protection devices (EPDs) were used in 18% (n = 383) of PCIs for saphenous vein grafts (SVG-PCI) with a significant variation in its use among institutions (number of PCI: hospitals that had never used an EPD vs. EPD used one or more times = 240 vs. 345, p < .001). The EPDs used in the SVG-PCI group had a significantly lower prevalence of the slow-flow phenomenon after adjusting for covariates (OR 0.45, 95% CI 0.21-0.91, p = .04). Conclusion:GV-PCI is associated with an increased risk of in-hospital mortality. EDP use in SVG-PCI was associated with a low rate of the slow-flow phenomenon. The usage of EPDs during SVG-PCI is low, with a significant variation among institutions.

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“…4,5 Enthusiasm for ELCA was tempered by elevated complication rates compared with percutaneous transluminal coronary angioplasty alone, 6 further reports suggesting a marginal benefit of luminal gain with ELCA pretreatment 7 and the refinement of coronary stents and other atherectomy devices, such as rotational atherectomy. 8 More recently, ELCA has seen a resurgence for use in complex coronary disease in some centers 9 and has shown effectiveness in the treatment of in-stent restenosis (ISR), 10 debulking of SVG lesions, 11 facilitating CTO interventions, 12 and treatment of thrombotic lesions. 13 A recent large registry study from the UK confirmed an increased use of ELCA with an additional increased risk of dissection, perforation, and slow flow compared with non-ELCA interventions.…”

mentioning

confidence: 99%

Excimer Laser Coronary Angioplasty in Coronary Lesions: Use and Safety From the NCDR/CATH PCI Registry

Sintek

Coverstone

Bach

et al. 2021

Circ: Cardiovascular Interventions

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Background: Excimer laser coronary angioplasty (ELCA) uses a ultraviolet laser catheter for the treatment of coronary artery disease. ELCA has been used for various coronary lesions, but current safety and frequency of use are unknown. Methods: We performed a retrospective, registry-based study of ELCA use during coronary interventions reported to the National Cardiovascular Data Registry/CATH percutaneous coronary intervention registry from 2009 to 2018 (n=6 043 596 total interventions evaluated). The primary safety end point was the combination of any perforation, dissection, tamponade, or death. ELCA use per 10 000 interventions was evaluated for the study duration. Subgroups of interest were identified including in-stent restenosis lesions, saphenous vein graft lesions, chronic total occlusions, and thrombotic lesions. Results: A total of 19 688 lesions were identified with ELCA use (0.3% of all lesions). The rate of ELCA use increased across the study period from 14 ELCAs performed per 10 000 interventions in 2009 to 70 ELCAs performed per 10 000 interventions in 2018. The primary safety end point occurred in 4.2% of lesions and was higher than in cases where no ELCA was used (3.0% P <0.001). After adjusting for baseline differences among the subgroups who received ELCA, the in-stent restenosis group had the lowest rate of complications (odds ratio, 0.51 [95% CI, 0.42–0.63]), followed by the saphenous vein graft group (odds ratio, 0.72 [95% CI, 0.5–1]). The chronic total occlusion group had a higher risk for complications (odds ratio, 2.01 [95% CI, 1.61–2.40]). Conclusions: The use of ELCA has remained low but has increased in recent years. Complications are significantly higher when ELCA is used, but this effect is variable with respect to lesion subtype. ELCA is frequently used to treat in-stent restenosis with a low risk of complication. ELCA use during chronic total occlusion interventions is associated with a 2-fold increased risk of complications. Together these findings provide guidance for lesion selection to optimize safety with ELCA use.

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Case-Control Registry of Excimer Laser Coronary Angioplasty Versus Distal Protection Devices in Patients With Acute Coronary Syndromes due to Saphenous Vein Graft Disease

Cited by 26 publications

References 30 publications

Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery

Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery

In‐hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry

Excimer Laser Coronary Angioplasty in Coronary Lesions: Use and Safety From the NCDR/CATH PCI Registry

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