Abstract:Excimer laser coronary angioplasty (ELCA) is a unique revascularization modality that can vaporize plaque and thrombus. Compared to thrombus aspiration therapy, ELCA is reported to provide better microcirculation and reduced peripheral embolism in treatment for acute coronary syndrome. Excimer laser catheters come in various sizes, and we sought to compare the 0.9-and 1.4-mm-diameter catheters. We retrospectively enrolled 90 acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary… Show more
“…Bailout stenting was performed for a significantly greater percentage of patients in the ELCA than in the conventional group (11.1% vs. 1.1%, p = 0.036). Additionally, ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high Laser catheters employed in the ELCA group usually had a diameter of 0.9 mm (n = 24), followed by 1.4 mm (n = 3), and 1.7 mm (n = 1), which was in agreement with our previous study [14] (Table 3). On an average, the maximum fluence was 53.7 mJ/mm 2 , the maximum frequency was 34.6 Hz, and the train count was 8.7.…”
Section: Data Collection/analysissupporting
confidence: 91%
“…In the recent years, ELCA has proved to be a promising strategy for the treatment of complex PCIs [15], such as in-stent restenosis [16] and chronic total occlusion [17]. ELCA was also safely and efficiently used for myocardial salvage in patients with ST-elevation myocardial infarction [18], for lead extraction of cardiac implantable devices [19], for acute coronary syndrome [20], and acute myocardial infarction [14].…”
This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest-incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)-were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan-Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614-8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.
“…Bailout stenting was performed for a significantly greater percentage of patients in the ELCA than in the conventional group (11.1% vs. 1.1%, p = 0.036). Additionally, ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high Laser catheters employed in the ELCA group usually had a diameter of 0.9 mm (n = 24), followed by 1.4 mm (n = 3), and 1.7 mm (n = 1), which was in agreement with our previous study [14] (Table 3). On an average, the maximum fluence was 53.7 mJ/mm 2 , the maximum frequency was 34.6 Hz, and the train count was 8.7.…”
Section: Data Collection/analysissupporting
confidence: 91%
“…In the recent years, ELCA has proved to be a promising strategy for the treatment of complex PCIs [15], such as in-stent restenosis [16] and chronic total occlusion [17]. ELCA was also safely and efficiently used for myocardial salvage in patients with ST-elevation myocardial infarction [18], for lead extraction of cardiac implantable devices [19], for acute coronary syndrome [20], and acute myocardial infarction [14].…”
This study aimed to evaluate the efficacy and safety of excimer laser coronary atherectomy (ELCA) prior to paclitaxel-coated balloon angioplasty for de novo coronary artery lesions. This retrospective observational study analyzed 118 eligible patients with de novo coronary artery disease whose only percutaneous coronary intervention was a drug-coated balloon angioplasty (i.e., no subsequent stent placement). Data related to our primary outcomes of interest-incidence of major adverse cardiovascular and cerebral events (MACCE), and incidence of procedural complications (bailout stenting and minor complications)-were collected and retrospectively analyzed. ELCA was used significantly more often in the cases of main branch and ostial lesions (i.e., of the circumflex, right coronary, or left anterior descending arteries, or high lateral branch), normally associated with poor treatment outcomes (55.6% vs. 14.3%, p < 0.0005). However, the two groups were not different in terms of cumulative incidence as estimated by the Kaplan-Meier method (log-rank test, p = 0.603) and a causal relationship between ELCA and MACCE was not identified (OR, 2.223; 95% CI, 0.614-8.047; p = 0.223). This study confirms the safety of ELCA prior to paclitaxel DCB angioplasty to treat de novo coronary artery lesions. While difficult-to-treat lesions were significantly more prevalent in the group treated by ELCA, the study revealed similar efficiency as conventional pre-dilation methods. Our findings provide grounds for a prospective randomized trial with consistent lesion and procedural characteristics to evaluate the potential benefits of combining paclitaxel DCB angioplasty following ELCA for de novo coronary artery lesions.
“…Based on our previous study, we have a tendency to use the smaller 0.9-mm excimer laser catheter (Fig. 2B ) [ 13 ]. Fig.…”
Section: Methodsmentioning
confidence: 99%
“…In addition, ELCA has also been applied to a variety of difficult-to-treat lesions, including preparation before drug-coated balloon angioplasty [10]. ELCA improves thrombolysis in myocardial infarction (TIMI) frame count or myocardial blush grade (MBG) in patients with AMI [11][12][13]. However, clinical data supporting the utilization of ELCA in AMI remain scarce [14,15].…”
Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, β-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022–0.959, p = 0.045; OR, 0.077, 95% CI, 0.007–0.805, p = 0.032; OR, 6.494, 95% CI, 1.228–34.34, p = 0.028; OR, 0.890, 95% CI, 0.828–0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era.
“…The major advantage of laser catheters is that it is compatible with any standard 0.014-inch guidewire. The ELCA catheters are designed in four diameters: 0.9, 1.4, 1.7, and 2.0 mm, the 0.9 mm ELCA catheter is sufficient for the treatment of CAD [ 115 ]. The 0.9-mm catheter has the ability to emit high power (80 mJ/mm 2 ) and laser energy at the highest repetition rate (80 Hz).…”
Section: Research Progress and Applications Of Laser Technology In Intravascular Imaging And Treatmentmentioning
Blood vessels are one of the most essential organs, which nourish all tissues in our body. Once there are intravascular plaques or vascular occlusion, other organs and circulatory systems will not work properly. Therefore, it is necessary to detect abnormal blood vessels by intravascular imaging technologies for subsequent vascular treatment. The emergence of lasers and fiber optics promotes the development of intravascular imaging and treatment. Laser imaging techniques can obtain deep vascular images owing to light scattering and absorption properties. Moreover, photothermal and photomechanical effects of laser make it possible to treat vascular diseases accurately. In this review, we present the research progress and applications of laser techniques in intravascular imaging and treatment. Firstly, we introduce intravascular optical coherent tomography and intravascular photoacoustic imaging, which can obtain various information of plaques. Multimodal intravascular imaging techniques provide more information about intravascular plaques, which have an essential influence on intravascular imaging. Secondly, two laser techniques including laser angioplasty and endovenous laser ablation are discussed for the treatment of arterial and venous diseases, respectively. Finally, the outlook of laser techniques in blood vessels, as well as the integration of laser imaging and treatment are prospected in the section of discussions.
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