Excimer Laser-Assisted Angioplasty for Infrainguinal Artery Disease

Abstract

After nearly 2 decades of research and experimentation with laser-assisted angioplasty, the xenon-hydrogen chloride excimer laser emerged as the laser device best suited for the treatment of peripheral artery disease. Emitting light at a wavelength of 308 nm, this laser utilizes a nonthermal mechanism of action to ablate plaque and thrombus in powerful discrete pulses. The excimer laser is particularly useful for the treatment of complex conditions, such as long chronic occlusions in the superficial femoral artery and in those patients with below-the-knee disease and critical limb ischemia who may not be good candidates for bypass surgery. A number of investigators have noted that the excimer laser will often uncover distinct, more focal lesions in what appears to be an extensive and complex occlusion, potentially simplifying treatment of these segments. The Laser Angioplasty for Critical Limb Ischemia phase 2 trial, a prospective registry of 145 patients at 11 US and 3 German sites, achieved good procedural success (86%) and an excellent 6-month limb salvage rate (93%). A new specialized deflecting sheath designed to direct excimer ablation in blockages of the larger main arteries above the knee has produced clinical improvement in a single-center feasibility study and a 16-center prospective registry. Less promising results were reported in a single-center real-world retrospective registry, warranting careful case selection with this device for patients with diabetes and renal failure.

Transpopliteal Balloon-Assisted Excimer–Laser Atherectomy for the Treatment of Chronic Femoropopliteal Occlusions: Feasibility and Initial Results

“… 30 In patients with critical limb ischemia, who were not good candidates for surgical procedures/bypass, ELA showed a promising low amputation rate after 6 months. 31 In our own experience, in the treatment of long TASC C and D lesions, ELA showed good technical success rates with low complication rates. 11 The long-term results are good in light of the complexity of the lesions but depend on a conscientious follow-up care.…”

TASC II and the Endovascular Management of Infrainguinal Disease

“…[34][35][36][37][38] Data from several reports featuring these devices do support the TASC II reclassification of femoropopliteal lesions. In a 16-center registry study, Laird et al 39 40 The multicenter Laser Atherectomy for Critical Ischemia (LACI) trial of the CLIRpath Photoablation Atherectomy System involved 423 lesions (41% SFA, 15% popliteal, 41% infrapopliteal; 60% TASC I type D, 28% type C; 11.0-cm median length of treated artery) in 155 limbs (91% with at least 1 occlusion) of 145 CLI patients who were determined to be poor candidates for surgical revascularization.…”

Comparison of Immediate and 2‐Year Outcomes between Excimer Laser‐Assisted Angioplasty with Spot Stent and Primary Stenting in Intermediate to Long Femoropopliteal Disease

“…Debulking the segment with the excimer laser can uncover these more modest lesions that can then be focally treated with balloon angioplasty and, if necessary, spot stenting [10–12]. Scheinert et al analyzed 318 patients who underwent ELA of 411 lesions averaging 19.4 ± 6.0 cm in length with a 90.5% procedure success rate.…”

“…The excimer laser application has been studied in long SFA occlusions, which are sometimes made up of several focal stenoses that appear angiographically as a lengthy total occlusion. Debulking the segment with the excimer laser can uncover these more modest lesions that can then be focally treated with balloon angioplasty and, if necessary, spot stenting [ 10 – 12 ]. Scheinert et al analyzed 318 patients who underwent ELA of 411 lesions averaging 19.4 ± 6.0 cm in length with a 90.5% procedure success rate.…”