Contrast-enhanced excimer laser stepwise approach during PCI for resistant coronary lesions.
calcified coronary lesions
complex PCI
complex coronary lesions
excimer laser coronary atherectomy
in‐stent restenosis
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
03 Jul 2024
03 Jul 2024
Historique:
revised:
06
01
2024
received:
10
09
2023
accepted:
18
06
2024
medline:
3
7
2024
pubmed:
3
7
2024
entrez:
3
7
2024
Statut:
aheadofprint
Résumé
The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power. To evaluate the effectiveness and safety of the contrast-enhanced ELCA by a stepwise approach in the treatment of RCLs. We retrospectively examined consecutive patients undergoing contrast-enhanced ELCA-assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in-stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in-stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast-enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively). The contrast-enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in-stent-resistant coronary lesions.
Sections du résumé
BACKGROUND
BACKGROUND
The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power.
AIM
OBJECTIVE
To evaluate the effectiveness and safety of the contrast-enhanced ELCA by a stepwise approach in the treatment of RCLs.
METHODS
METHODS
We retrospectively examined consecutive patients undergoing contrast-enhanced ELCA-assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in-stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis.
RESULTS
RESULTS
We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in-stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast-enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively).
CONCLUSIONS
CONCLUSIONS
The contrast-enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in-stent-resistant coronary lesions.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Généreux P, Madhavan MV, Mintz GS, et al. Ischemic outcomes after coronary intervention of calcified vessels in acute coronary syndromes. Pooled analysis from the HORIZONS‐AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) TRIALS. J Am Coll Cardiol. 2014;63:1845‐1854.
Mintz GS, Popma JJ, Pichard AD, et al. Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation. 1995;91:1959‐1965.
Angsubhakorn N, Kang N, Fearon C, et al. Contemporary management of severely calcified coronary lesions. J Pers Med. 2022;12:1638.
Fernandez JP, Hobson AR, McKenzie D, et al. Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non‐crossable and non‐expansible coronary lesions. EuroIntervention. 2013;9:243‐250.
Caminiti R, Vetta G, Parlavecchio A, et al. A systematic review and meta‐analysis including 354 patients from 13 studies of intravascular lithotripsy for the treatment of underexpanded coronary stents. Am J Cardiol. 2023;205:223‐230.
Andò G, Vizzari G, Niccoli G, et al. A nome del gruppo di studio “cardiologia interventistica” della società italiana di cardiologia. [Evaluation and percutaneous treatment of severely calcified coronary lesions]. G Ital Cardiol. 2006;2021(22):480‐489.
Eigler NL, Weinstock B, Douglas JS, et al. Excimer laser coronary angioplasty of aorto‐ostial stenoses. Results of the excimer laser coronary angioplasty (ELCA) registry in the first 200 patients. Circulation. 1993;88:2049‐2057.
Tsutsui RS, Sammour Y, Kalra A, et al. Excimer laser atherectomy in percutaneous coronary intervention: a contemporary review. Cardiovasc Revasc Med. 2021;25:75‐85.
Litvack F, Eigler N, Margolis J, et al. Percutaneous excimer laser coronary angioplasty: Results in the first consecutive 3,000 patients. J Am Coll Cardiol. 1994;23:323‐329.
Latib A, Takagi K, Chizzola G, et al. Excimer laser LEsion modification to expand non‐dilatable stents: the ELLEMENT registry. Cardiovasc Revasc Med. 2014;15:8‐12.
Garcia‐Garcia HM, McFadden EP, Farb A, et al. Standardized end point definitions for coronary intervention trials. Eur Heart J. 2018;39:2192‐2207.
Reifart N, Vandormael M, Krajcar M, et al. Randomized comparison of angioplasty of complex coronary lesions at a single center. excimer laser, rotational atherectomy, and balloon angioplasty comparison (ERBAC) study. Circulation. 1997;96:91‐98.
Golino L, Caiazzo G, Calabrò P, et al. Excimer laser technology in percutaneous coronary interventions: cardiovascular laser society's position paper. Int J Cardiol. 2022;350:19‐26.
Ambrosini V, Sorropago G, Laurenzano E, et al. Early outcome of high energy laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloon‐resistant coronary lesions: LEONARDO study. Cardiovasc Revasc Med. 2015;16:141‐146.
Karacsonyi J, Armstrong EJ, Truong HTD, et al. Contemporary use of laser during percutaneous coronary interventions: insights from the laser veterans affairs (LAVA) multicenter registry. J Invasive Cardiol. 2018;30:195‐201.
Shibui T, Tsuchiyama T, Masuda S, Nagamine S. Excimer laser coronary atherectomy prior to paclitaxel‐coated balloon angioplasty for de novo coronary artery lesions. Lasers Med Sci. 2021;36:111‐117.
Veerasamy M, Gamal AS, Jabbar A, Ahmed JM, Egred M. Excimer laser with and without contrast for the management of under‐expanded stents. J Invasive Cardiol. 2017;29:364‐369.
Tonomura D, Shimada Y, Yamanaka Y, et al. Laser vaporization of atherothrombotic burden before drug‐coated balloon application in ST‐segment elevation myocardial infarction: two‐year outcomes of the laser‐DCB trial. Catheter Cardiovasc Interv. 2022;99:1758‐1765.
Li H, Ai H, Li L, et al. The therapeutic effects of excimer laser coronary atherectomy therapy for in‐stent restenosis chronic total occlusions. BMC Cardiovasc Disord. 2021;21:399.