Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry

Ojeda, Soledad; Azzalini, Lorenzo; Lezo, Javier Suárez de; Johal, Gurpreet; Gonzalez, Rafael; Barman, Nitin; Hidalgo, Francisco; Bellera, Neus; Dangas, George; Jurado-Román, Alfonso; Kini, Annapoorna; Romero, Miguel; Moreno, Raúl; Blanco, Bruno García del; Mehran, Roxana; Sharma, Samin K.; Pan, Manuel

doi:10.1002/ccd.29392

Cited by 17 publications

(16 citation statements)

References 21 publications

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“…In addition, although the selection of a newer generation of DES and the optimization of postprocedural minimal lumen diameter to obtain optimal acute angiographic results could improve long-term outcomes, these approaches are required for all target lesions. Unlike other contributors, CAC could be identified and quantified before the procedure and be theoretically ‘modifiable’ for better stent deployment and expansion during the procedure with the use of more aggressive interventional approaches, such as cutting ballooning [21], rotational atherectomy [21,22], orbital atherectomy [23], excimer laser coronary atherectomy [24] and coronary intravascular lithotripsy [25]. These approaches could be planned even before conducting the invasive procedure.…”

Section: Discussionmentioning

confidence: 99%

Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation

Zheng¹,

Xu²,

Yang³

et al. 2022

Coronary Artery Disease

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Background Coronary artery calcium (CAC) is a modifiable contributor of in-stent restenosis (ISR), but quantitative analyses using a noninvasive approach are limited. We aimed to investigate the associations between CAC score derived from ECG-gated coronary computed tomography angiography (CCTA) or non-gated noncontrast chest computed tomography (NCCT) and ISR. MethodsWe included 368 lesions in 194 patients with coronary drug-eluting stent implantations in final analyses. CAC was quantified using the Agatston score. Primary endpoint was ISR, defined as lumen diameter stenosis over 50% at the stent segment or its proximal or distal edges (5-mm segments adjacent to the stent), at angiographic follow-up. ResultsThe CAC scores in either CCTA/2.5 mm group (r = 0.7702; P < 0.0001) or NCCT/5 mm group (r = 0.7105; P < 0.0001) were both correlated with in-stent diameter stenosis. The receiver-operating characteristic curve analysis identified a CAC score >245 in CCTA/2.5 mm group as the optimal ISR cutoff (sensitivity, 60.0%; specificity, 83.7%; area under the curve, 0.744; P < 0.001), and >209 in NCCT/5 mm group (sensitivity, 46.7%; specificity, 91.9%; area under the curve, 0.704; P < 0.001). Multivariable logistic regression models indicated a CAC score >245 in CCTA/2.5 mm group and >209 in NCCT/5 mm group independently associated with an 8.46and 21.89-fold increase in ISR, respectively (all P < 0.01).Conclusions Either a CAC score >245 in CCTA/2.5 mm or >209 in NCCT/5 mm was significantly associated with increased risk in ISR.

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Section: Discussionmentioning

confidence: 99%

Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation

Zheng¹,

Xu²,

Yang³

et al. 2022

Coronary Artery Disease

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“…RA can be very useful in this setting by debulking lesions with severe calcification to improve vascular compliance and device trafficability. A recent multicentral study suggested that excimer laser coronary atherectomy was effective in uncrossable CTO lesions (21). Although there is a lack of sufficient practice, we are optimistic about its prospects.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries

Wang

Huang

Yakubu

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo evaluate the safety and feasibility of rotational atherectomy (RA) in retrograde chronic total occlusion percutaneous coronary intervention (CTO-PCI) by analyzing immediate and long-term outcomes.BackgroundRecent evidence supports the safety and feasibility of RA in CTO-PCI. However, few studies have focused on the use of RA in a retrograde approach to percutaneous revascularization of chronic total occlusion (CTO) lesions and information on long-term outcomes is lacking.MethodsA total of 329 patients who underwent retrograde CTO-PCI, out of 1496 consecutive CTO-PCI patients from April 2017 to July 2020, were retrospectively recruited from the 2nd Cardiology Department of the Guangdong Provincial People's Hospital. 16 patients underwent RA (RA group) whilst 313 did not (non-RA group).ResultsTechnical (87.5% vs. 87.5) and procedural (85.9% vs. 87.5) success rates were similar between both groups. There was no difference concerning major procedural complications between groups (12.5% vs. 19.2%; p > 0.75). No in-hospital MACCEs was recorded in the RA group while there were eight MACCEs in the non-RA group (p > 0.99). In the RA group, 2 cases recorded perforation (1 target vessel perforation case and 1 branch vessel perforation), and 55 cases of vessel perforations/dissections were recorded in non-RA group including 18 target vessel perforations, 2 branch vessel perforations, 35 collateral vessel perforations (one patient died from cardiac tamponade). No difference was found in terms of the perforation rate between the two groups (p > 0.99). Over a mean follow-up period of 26.47 ± 14.46 months, use of RA in retrograde CTO-PCI did not result in an increased mortality rate [hazard ratio (HR) 1.58, 95% confidence interval (CI), 0.31–8.21, p = 0.65], major adverse cardiac and cerebral events (HR 0.99, 95% CI 0.35–2.79, p = 0.99) or overall rehospitalization rate (HR 1.27, 95% CI 0.44–3.67, p = 0.67). Adjusted Kaplan–Meier curves according to Cox regression model suggested several predictors influencing the all-cause mortality, cardiovascular mortality, MACCEs, stroke rate, non-fatal myocardial infarction, target vessel recanalization rate and rehospitalization rate in the comparison.ConclusionsOur study demonstrates that the in-hospital outcomes and long-term follow up events were the same between RA and non-RA retrograde CTO-PCI patients. RA offered an option for skillful operators in difficult cases when the lesion was severely calcified in retrograde CTO-PCI.

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“…Currently, ELCA is commonly used in highly complex lesions, including saphenous vein grafts, calcifications, tortuosity (moderate/severe), in-stent restenosis, and bifurcations, and carries the dual benefit of low rates of major adverse cardiovascular complications and high technical and procedural success rates[ 5 , 6 ]. We present the first case of a severe calcified ostium lesion treated with ELCA and balloon dilatation.…”

Section: Discussionmentioning

confidence: 99%

Excimer laser coronary atherectomy for a severe calcified coronary ostium lesion: A case report

Hou¹,

Ma²,

Zhou³

et al. 2021

WJCC

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BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content. Excimer laser coronary atherectomy (ELCA) is a less common treatment for severe calcified coronary ostium lesions. CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain. Coronary angiography showed severe calcific stenosis (approximately 90%) in the right coronary artery ostium. The right coronary artery ostium was unable to be advanced using a 2.5 mm × 12.0 mm balloon (NC Sprinter, Medtronic, United States) or dilated using a 2.0 mm × 12.0 mm balloon (Sprinter, Medtronic, United States). The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion. CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.

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Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry

Cited by 17 publications

References 21 publications

Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation

Association between coronary artery calcium score and in-stent restenosis after drug-eluting stent implantation

Safety and Feasibility of Rotational Atherectomy for Retrograde Recanalization of Chronically Occluded Coronary Arteries

Excimer laser coronary atherectomy for a severe calcified coronary ostium lesion: A case report

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