Excimer Laser Coronary Atherectomy to Treat Calcified Lesions

Abstract

We read with great interest the review entitled Best Practice in Intravascular Lithotripsy by Honton and Monsegui published recently in Interventional Cardiology. 1 We fully agree with the authors on the benefits of intravascular lithotripsy (IVL), a technology that has changed the treatment of calcified lesions because of its safety and efficacy, as well as having potential advantages over other plaque modification techniques. Its main limitation is the crossing profile when treating a very tight and severely calcified stenosis where rotational (RA) or orbital atherectomy (OA) are very useful, as the authors describe.We also believe these techniques are complementary. Indeed, we have seen with interest the growing use of the rotatripsy technique (a

Combination of Laser Atherectomy and Super High-pressure Non-compliant Balloon to Treat Stent Under-expansion in Cases of Failed Interventional Options

“…[ 24 ] The authors agree with Vera-Vera et al, who had some specific suggestions to the proposed algorithm, namely the use of ELCA in moderate/severe calcified lesions. [ 25 ] The authors believe that in the specific subset of patients presenting with severe stent under-expansion, after failure of NC ballooning and rotablation, it would be reasonable to use ELCA subsequently followed by the use of super high-pressure balloon. As described above OPN NC balloon behaves as a regular NC balloon under 30 atm.…”

“…These algorithm options are proposed for highly calcified, resistant lesions, but can be partially applied in stent under-expansion treatment. [ 24 , 25 ] Once the vessel preparation is complete, the lesion can be treated according to guidelines as it was in the present case. [ 26 , 27 ]…”

An analysis of long‐term clinical outcome following the use of excimer laser coronary atherectomy in a large UK PCI center

“…Excimer laser coronary atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI). [1][2][3][4][5][6] The main indications for the use of ELCA during PCI are targeted at lesion preparation. These include management of uncrossable stenoses and undilatable lesions, debulking in stent restenosis (ISR) and optimizing under-expanded stents and finally ablation of thrombus.…”

“…These include management of uncrossable stenoses and undilatable lesions, debulking in stent restenosis (ISR) and optimizing under-expanded stents and finally ablation of thrombus. [1][2][3][4][6][7][8] Through the development of ELCA technology and improvements in operator technique this tool has established a role in many complex PCI algorithms. 1,3,5 Despite the relatively simple learning curve for an atherectomy device, ELCA use has mainly been limited to a few selected high-volume PCI centers largely due to fiscal considerations.…”

“…Excimer laser coronary atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI) 1–6 . The main indications for the use of ELCA during PCI are targeted at lesion preparation.…”