Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent

Sunew, John; Chandwaney, Raj; Stein, David; Meyers, Sheridan N.; Davidson, Charles J.

doi:10.1002/ccd.1212

Cited by 25 publications

(16 citation statements)

References 23 publications

(30 reference statements)

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“…ELCA has been mainly used for debulking and modifying plaque before stenting in complex lesions; such as calcified lesions , thrombotic lesions , in‐stent restenosis , and chronic total occlusions . There have been reports describing management of plaque and calcification behind under‐expanded stents using ELCA . Egred performed ELCA inside an under‐expanded stent deployed in a severely calcified lesion to debulk and soften calcification behind the stent.…”

Section: Discussionmentioning

confidence: 99%

“…The absorption of laser energy by blood and contrast medium leads to fast vapor bubble expansion and implosion, causing explosive dilation and invagination of adjacent vessel wall . Although the use of continuous saline flush is recommended to reduce excessive vessel injury , there have been some reports of the use of ELCA with contrast injection . Lam et al performed ELCA with concomitant contrast injection during lasing instead of continuous saline flush to manage a newly deployed, under‐expanded stent .…”

Section: Discussionmentioning

confidence: 99%

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Successful retrieval of an entrapped guide wire between a deployed coronary stent and severely calcified vessel wall using excimer laser coronary atherectomy

Kadohira

Schwarcz

Gregorio

2014

Cathet Cardio Intervent

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We report the successful retrieval of an entrapped interventional guide wire between a newly deployed coronary stent and severely calcified vessel wall. Using a buddy wire technique, the stent was deployed at high pressure in a culprit lesion of the left anterior descending (LAD) artery. The buddy wire in the LAD artery was entrapped between the deployed stent and severely calcified vessel wall, as it was not removed before stent deployment, and could not be retrieved. Neither balloon catheters nor a microcatheter were able to be advanced behind the stent over the entrapped guide wire. Excimer laser coronary atherectomy (ELCA) was performed within the stent to modify and soften the calcification behind the deployed stent. Consequently, the entrapped guide wire was retrieved successfully and safely. This case illustrates that ELCA can be utilized to retrieve an entrapped guide wire between a deployed stent and calcified vessel wall.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful retrieval of an entrapped guide wire between a deployed coronary stent and severely calcified vessel wall using excimer laser coronary atherectomy

Kadohira

Schwarcz

Gregorio

2014

Cathet Cardio Intervent

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“…There was no complication. Management of refractory stent under‐expansion by laser angioplasty has been reported for a newly deployed stent as a staged procedure or in the context of in‐stent restenosis .…”

Section: Discussionmentioning

confidence: 99%

Excimer laser in management of underexpansion of a newly deployed coronary stent

Lam

Bertog

Sievert

2013

Cathet Cardio Intervent

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We report the successful management of underexpansion of a newly deployed coronary stent refractory to balloon dilatations. Direct stenting was performed for a lesion in the mid left anterior descending artery (without angiographically apparent heavy coronary calcification). The stent remained underexpanded despite repeated balloon dilatations including with high-pressure inflations. Subsequently, an excimer laser catheter was used in an attempt to vaporize the plaque by the accoustomechanical effect of the rapidly exploding bubbles. The overall angiographic result was good after further balloon dilatation with ordinary pressure and full stent expansion was achieved. Management of underexpansion of a newly deployed stent is a potential indication of laser angioplasty.

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“…34,35 While having no impact on the calcification itself, ELCA modifies the plaque behind the stent, which weakens the overall resistance, thus enabling subsequent complete stent expansion. [36][37][38] We have found that delivering high power laser energy (80 mJ/mm 2 / 80 Hz), using the 0.9-mm X80 catheter in the absence of saline, or with contrast injection, amplifies the ablative effect. Within a stented environment 'contrast-mileu' lasing appears to be safe, facilitating high-pressure balloon stent expansion.…”

Section: Excimer Laser Coronary Atherectomy In Underexpanded Stents (Seementioning

confidence: 99%

“…Within a stented environment 'contrast-mileu' lasing appears to be safe, facilitating high-pressure balloon stent expansion. [36][37][38][39] This technique has been evaluated in the ELLEMENT registry of 28 patients. 40 Procedural success was achieved in 96.4 % (27/28) of cases, using an increase of either 1 cm 2 on intravenous ultrasound (IVUS) or 10 % using quantitative coronary angiography derived minimal stent diameter as a definition.…”

Section: Excimer Laser Coronary Atherectomy In Underexpanded Stents (Seementioning

confidence: 99%

Coronary Intervention with the Excimer Laser: Review of the Technology and Outcome Data

Rawlins

Din

Talwar

et al. 2016

Interventional Cardiology Review

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Excimer laser coronary atherectomy (ELCA) is a long-established adjunctive therapy that can be applied during percutaneous coronary intervention (PCI). Technical aspects have evolved and there is an established safety and efficacy record across a number of clinical indications in contemporary interventional practice where complex lesions are routinely encountered. The role of ELCA during PCI for thrombus, non-crossable or non-expandable lesions, chronic occlusions and stent under-expansion are discussed in this review.The key advantage of ELCA over alternative atherectomy interventions is delivery on a standard 0.014-inch guidewire. Additionally, the technique can be mastered by any operator after a short period of training. The major limitation is presence of heavy calcification although when rotational atherectomy (RA) is required but cannot be applied due to inability to deliver the dedicated RotaWire TM (Boston Scientific), ELCA can create an upstream channel to permit RotaWire passage and complete the case with RA -the RASER technique. KeywordsExcimer laser coronary atherectomy (ELCA); percutaneous coronary intervention (PCI); non-crossable lesions; chronic total occlusions (CTO); intra-coronary thrombus; under-expanded stents; rotational atherectomy (RA) Disclosure: ST and PO are European Proctors for Spectranetics. JR and JD have no conflicts of interest to declare.

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Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent

Abstract: A patient is described in which excimer laser percutaneous coronary intervention is performed inside a suboptimally expanded stent due to nondilatable calcified plaque. The use of excimer laser facilitated full expansion of the stent with a balloon.

Cited by 25 publications

References 23 publications

Successful retrieval of an entrapped guide wire between a deployed coronary stent and severely calcified vessel wall using excimer laser coronary atherectomy

Successful retrieval of an entrapped guide wire between a deployed coronary stent and severely calcified vessel wall using excimer laser coronary atherectomy

Excimer laser in management of underexpansion of a newly deployed coronary stent

Coronary Intervention with the Excimer Laser: Review of the Technology and Outcome Data

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