Laser Coronary Angioplasty

Abstract

The efficacy of percutaneous transluminal coronary angioplasty (PTCA) is limited by remaining plaque tissue and the development of restenosis. It has been demonstrated that the restenosis rate is low if a large lumen diameter is achieved after coronary intervention. Debulking of coronary stenoses is a concept to increase the luminal diameter after intervention. Laser angioplasty debulks coronary stenoses by ablation of atherosclerotic plaque. Since the first intravascular laser intervention, the technique has been significantly improved by the use of optimized wavelength, the development of flexible optimally spaced multifiber catheters and an additional saline flush technique. These technical advancements allowed a reduction in the incidence of adverse events, such as the number of dissections and perforations, associated with the use of the laser technique. Coronary laser angioplasty is commonly combined with adjunctive balloon angioplasty to optimize the outcome. Laser coronary angioplasty was not followed by a lower restenosis rate compared with plain balloon angioplasty in lesions without stents, however, a randomized comparison of the techniques including the use of the saline flush technique is not available yet. The value of excimer (acronym for excited dimer) laser coronary angioplasty for treatment of in-stent restenosis is still under investigation. So far, nonrandomized single center studies have not suggested a relevant benefit for this technique used for in-stent restenosis. In nonstented lesions there remain niche indications for laser angioplasty such as the treatment of ostial lesions, diffuse lesions or lesions traversable with a guidewire but not with an angioplasty balloon. Laser coronary angioplasty may also be useful after a failed balloon angioplasty and in patients with chronic total occlusions. The potential advantages of combining laser coronary angioplasty with vaporization of thrombus in patients with acute coronary syndromes are currently under evaluation.

Laser Coronary Atherectomy and polymeric coronary wires in uncrossable lesions – A word of caution

“…With improvement in operator experience and with advances in technology, ELCA has become a widespread tool in coronary intervention, being used in almost 50,000 procedures in USA in the last 30 years. [10,11] Coronary wires technology and ELCA.…”

“…Various approaches have been proposed to provide a successful advancement of low-profile coronary tools such as small balloons or microcatheters and nowadays one of the most often chosen is the excimer laser coronary atherectomy (ELCA). [8][9][10] ELCA uses a xenon-chloride monochromatic exciter laser to produce ultraviolet light that is absorbed by the plaque, releasing a pressure wave that leads to plaque vaporizing and debulking. [11] According to the LAVA registry [12] the most common indication for its use in the USA are balloon-uncrossable lesions (43.8% of patients), with a procedural success over 90% and a low incidence of complications.…”

Lasers in medicine

“…This makes the process clean and sharply localized, which is sometimes highly desirable. The interaction tissue volume is determined by spot Ablation is an important mode of action in ophthalmology (keratotomy, refractive keratophakia, epikeratophakia and corneal ablation) [102][103][104][105][106][107], surgery of joints [108], angioplasty [109][110][111] and lithotripsy [112]. In the latter case, stones are fragmented piece by piece by ablative processes.…”