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

Abstract

Background. Excimer laser coronary atherectomy (ELCA) represents one of the last available options in case of balloon uncrossable lesions but no bench testing or clinical experience has been reported with polymeric wires. We aimed to assess whether ECLA use can disrupt or melt the cover and coating of coronary wires. Methods. A total of 22 wires (10 polymer-jacketed and 12 hydrophilic non polymeric) were tested in an uncrossable lesion model. Two ELCA tests were performed over each wire at 8 and 4 cms from the tip with low and high settings, respectively. Microscopic analysis was performed at baseline images and after each test. Wire disruption was classified as Grade 1 (superficial scratches), Grade 2 (coil damage or solution of continuity of the polymeric cover) and Grade 3 (wire rupture/core disruption or de-coiling). Results. After 44 ELCA simulations, wire disruption occurred in 16 cases (36.3%). Overall, events were more common for polymer-jacketed than for hydrophilic wires (12 vs 4, p=0.004). No grade 3 events occurred. Grade 2 events occurred in 9 cases (20.5%) and were more frequent with polymer-jacketed wires (8 vs 1, p=0.006). With low ELCA settings only polymer-jacketed wires suffered disruption (5 vs 0, p=0.009). With higher settings 11 events occurred (7 of Grade 2 and 4 of Grade 1) and incidence of grade 2 events was higher for polymer-jacketed wires (6 vs 1, p=0.02). Conclusions. ELCA might be a safe option for coronary uncrossable lesions but its use with high settings over polymer-jacketed wires is discouraged.