Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

Harima, Ayako; Sairaku, Akinori; Inoue, Ichiro; Nishioka, Kenji; Oka, Takahiro; Nakama, Yasuharu; Dai, Kazuoki; Ohi, Kuniomi; Hashimoto, Harukichi; Kihara, Yasuki

doi:10.1111/joic.12495

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…A similar mechanism was previously reported in the case of in-stent restenosis [2]. For acute myocardial infarction, the combined use of ELCA and DCB for de-novo coronary artery disease works synergistically to reduce restenosis [3]. Stent-less strategy employing ELCA and DCB may be an effective revascularization of large vessel denovo lesions, when traditional stent deployment is not a viable option.Informed consent was obtained from the patient in accordance with the Helsinki Declaration.…”

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confidence: 53%

A case of a de-novo lesion in the left circumflex artery treated with excimer laser and drug-coated balloon under the guidance of optical frequency domain imaging

et al. 2019

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A 72-year-old man who previously underwent percutaneous coronary intervention with a drugeluting stent implantation from the left main trunk and extending to proximal left anterior descending artery was admitted to the documented hospital for angina pectoris. Coronary angiography (CAG) revealed 90% stenosis at the ostium of the left circumflex artery (LCX) (Fig. 1A). Excimer laser coronary angioplasty (ELCA) was performed using a 0.9 mm concentric laser catheter at a pulse rate of 25 Hz and energy output of 45 mJ/mm 2 , 35 Hz and 55 mJ/mm 2 , and 45 Hz and 60 mJ/mm 2 for a total of 5200 pulses and balloon angioplasty using a drugcoated balloon (DCB) under the guidance of optical frequency domain imaging (OFDI), which revealed fibrous plaque and eccentric severe calcification ( Fig. 1B). After ELCA, minimum lumen area (MLA) increased from 1.4 mm 2 to 2.6 mm 2 (Fig. 1C) and on final OFDI to 3.9 mm 2 along with minor plaque dissection ( Fig. 1D). Final CAG demonstrated optimal result without flow limitation ( Fig 1E). After discharge, no significant clinical events were reported. Eight months later, follow-up CAG and OFDI were performed. Follow-up CAG demonstrated no restenosis at the ostium of the LCX (Fig. 1F). OFDI showed that the MLA slightly decreased from 3.9 mm 2 to 3.5 mm 2 and that the minor dissection had clearly improved (Fig. 1G). The DCB is efficacious in de-novo coronary artery lesions [1], which mainly contributed to suppress the restenosis in this case; however, although OFDI after ELCA demonstrated a slight increase in MLA, ELCA might be attributed to the lesion debulking and modification leading to optimal balloon expansion. A similar mechanism was previously reported in the case of in-stent restenosis [2]. For acute myocardial infarction, the combined use of ELCA and DCB for de-novo coronary artery disease works synergistically to reduce restenosis [3]. Stent-less strategy employing ELCA and DCB may be an effective revascularization of large vessel denovo lesions, when traditional stent deployment is not a viable option.Informed consent was obtained from the patient in accordance with the Helsinki Declaration. AcknowledgementsThe authors wish to thank Dr. Richard H. Kaszynski for reviewing and revising this manuscript.

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confidence: 53%

A case of a de-novo lesion in the left circumflex artery treated with excimer laser and drug-coated balloon under the guidance of optical frequency domain imaging

et al. 2019

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“…A recent study showed that 24 out of 86 patients with ACS treated with a drug-coated balloon and ELCA underwent unplanned stenting due to complications such as coronary dissection, residual thrombus, recoiling, failed laser catheter-delivery, slow-flow after laser application, and haemodynamic instability. 11 Therefore, selected patients without these findings might be candidates for ELCA without stenting.…”

Section: Discussionmentioning

confidence: 99%

Excimer laser coronary angioplasty without stenting in a 37-year-old man with acute coronary syndrome involving left main trunk: a case report

Shigeno,

Hirohata

2024

European Heart Journal - Case Reports

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Background Excimer laser coronary angioplasty (ELCA) is utilized to reduce thrombus in acute coronary syndrome (ACS). However, the feasibility and safety of ELCA for patients with ACS involving the left main trunk (LMT) and bifurcation, as well as the safety of a stentless strategy with ELCA, are not well-documented. Case Summary A 37-year-old man without any past medical history presented with chest pain. Electrocardiogram showed ST-segment elevation in leads I, aVL, and V2-V6. Emergent coronary angiography (CAG) showed a 99% stenosis from LMT to proximal left anterior descending artery (LAD). Intra-aortic balloon pumping (IABP) was initiated. Intravascular ultrasound revealed massive thrombus at the culprit lesion. Thrombus aspiration was not enough to reduce the thrombus, thus, we conducted thrombus vaporization with a 0.9-mm ELCA catheter. CAG after the procedure showed reduced thrombus with thrombolysis in myocardial infarction grade 3 flow. Considering his age and the complexity of stenting the LMT, we completed the procedure without stenting. After the intervention, we initiated triple antithrombotic therapy. On day 3, we removed the IABP. On day 11, CAG showed no significant stenosis. Optical coherence tomography revealed ulceration, indicating the presence of plaque disruption at the proximal LAD as the likely cause of thrombosis. With improvement in CAG findings, we stopped heparin and continued dual antiplatelet therapy. He was discharged on day 20. Discussion ELCA without stenting can be an option for the patients with ACS involving LMT, especially for younger patients who are suitable to avoid stenting on bifurcation lesions for lifelong management.

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“…Although receiving second-generation DES is the most common option for the treatment of patients with ACS and is generally considered the optimal strategy ( 65 ), some small sample size clinical trials have attempted to use the DCB-only strategy in primary percutaneous coronary intervention (PPCI) ( 54 , 55 , 66 – 68 ). Nicola et al conducted the first study of a DCB-only strategy in the setting of PPCI, and DPAT was scheduled to be continued for 12 months ( 66 ).…”

Section: Dapt Duration In Multiple Diseasesmentioning

confidence: 99%

Duration of Dual Antiplatelet Therapy After Implantation of Drug-Coated Balloon

Zhang

Dong

et al. 2021

Front. Cardiovasc. Med.

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The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device with theoretical advantages and promising results. Recent clinical observations have demonstrated that DCB tends to have both good efficacy and a good safety profile in the treatment of in-stent restenosis (ISR) for both bare-metal and drug-eluting stents (DES), de novo coronary artery disease (CAD), and other situation, such as high bleeding risk, chronic total occlusion, and acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) has become an essential medication in daily clinical practice, but the optimal duration of DAPT after the implantation of a DCB remains unknown. At the time of the first in vivo implantation of paclitaxel-DCB for the treatment of ISR in 2006, the protocol-defined DAPT duration was only 1 month. Subsequently, DAPT duration ranging from 1 to 12 months has been recommended by various trials. However, there have been no randomized controlled trials (RCTs) on the optimal duration of DAPT after DCB angioplasty. Current clinical guidelines normally recommend the duration of DAPT after DCB-only angioplasty based on data from RCTs on the optimal duration of DAPT after stenting. In this review, we summarized current clinical trials on DCB-only angioplasty for different types of CADs and their stipulated durations of DAPT, and compared their clinical results such as restenosis, target lesion revascularization (TLR) and stent thrombosis event. We hope this review can assist clinicians in making reasonable decisions about the duration of DAPT after DCB implantation.

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Real‐life experience of a stent‐less revascularization strategy using a combination of excimer laser and drug‐coated balloon for patients with acute coronary syndrome

Abstract: The stent-less revascularization strategy with DCB and ELCA was associated with a higher occurrence of restenosis in ACS patients.

Cited by 4 publications

References 21 publications

A case of a de-novo lesion in the left circumflex artery treated with excimer laser and drug-coated balloon under the guidance of optical frequency domain imaging

A case of a de-novo lesion in the left circumflex artery treated with excimer laser and drug-coated balloon under the guidance of optical frequency domain imaging

Excimer laser coronary angioplasty without stenting in a 37-year-old man with acute coronary syndrome involving left main trunk: a case report

Duration of Dual Antiplatelet Therapy After Implantation of Drug-Coated Balloon

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