Excimer laser coronary angioplasty: a mini-narrative review of clinical outcomes.
Clinical outcomes
Excimer laser coronary angioplasty
Percutaneous coronary intervention
Safety
Journal
The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology
ISSN: 2090-911X
Titre abrégé: Egypt Heart J
Pays: Germany
ID NLM: 9106952
Informations de publication
Date de publication:
16 Sep 2024
16 Sep 2024
Historique:
received:
18
12
2023
accepted:
09
09
2024
medline:
17
9
2024
pubmed:
17
9
2024
entrez:
16
9
2024
Statut:
epublish
Résumé
Excimer laser coronary angioplasty (ELCA) has evolved as a pivotal element in percutaneous coronary intervention (PCI), significantly influencing procedural efficacy and safety. This mini-narrative review explores ELCA's applications, focusing on its efficacy and clinical outcomes. BODY: A search of major databases identified studies from ELCA's inception. Inclusion criteria encompassed diverse study designs exploring ELCA in coronary interventions, with rigorous data extraction ensuring accuracy and completeness. A narrative synthesis presented key findings across studies. ELCA demonstrated promising outcomes compared to traditional PCI and stent placement. Reduced reperfusion time, enhanced microcirculation, and lower postoperative major adverse cardiac events (MACE) rates highlighted its efficacy. Improved vascular and lumen dynamics, plaque modification, and successful treatment of complex lesions showcased its versatility. Quality of life enhancements positively impacted long-term recovery, particularly in acute coronary syndrome (ACS) cases. ELCA's success in challenging scenarios and its role in refining in-stent restenosis (ISR) treatment indicated broader applications. Despite limitations in some studies, ELCA presented a favorable safety profile. The review underscores ELCA's dynamic role in coronary interventions, offering a promising tool for enhancing procedural outcomes. Clinical implications include improved reperfusion, adaptability in complex lesions, and potential long-term benefits for ACS patients. While integration into routine practice requires careful consideration, ELCA's positive outcomes encourage further exploration and innovation in interventional cardiology.
Sections du résumé
BACKGROUND
BACKGROUND
Excimer laser coronary angioplasty (ELCA) has evolved as a pivotal element in percutaneous coronary intervention (PCI), significantly influencing procedural efficacy and safety. This mini-narrative review explores ELCA's applications, focusing on its efficacy and clinical outcomes. BODY: A search of major databases identified studies from ELCA's inception. Inclusion criteria encompassed diverse study designs exploring ELCA in coronary interventions, with rigorous data extraction ensuring accuracy and completeness. A narrative synthesis presented key findings across studies. ELCA demonstrated promising outcomes compared to traditional PCI and stent placement. Reduced reperfusion time, enhanced microcirculation, and lower postoperative major adverse cardiac events (MACE) rates highlighted its efficacy. Improved vascular and lumen dynamics, plaque modification, and successful treatment of complex lesions showcased its versatility. Quality of life enhancements positively impacted long-term recovery, particularly in acute coronary syndrome (ACS) cases. ELCA's success in challenging scenarios and its role in refining in-stent restenosis (ISR) treatment indicated broader applications. Despite limitations in some studies, ELCA presented a favorable safety profile.
CONCLUSION
CONCLUSIONS
The review underscores ELCA's dynamic role in coronary interventions, offering a promising tool for enhancing procedural outcomes. Clinical implications include improved reperfusion, adaptability in complex lesions, and potential long-term benefits for ACS patients. While integration into routine practice requires careful consideration, ELCA's positive outcomes encourage further exploration and innovation in interventional cardiology.
Identifiants
pubmed: 39283510
doi: 10.1186/s43044-024-00561-8
pii: 10.1186/s43044-024-00561-8
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
129Informations de copyright
© 2024. The Author(s).
Références
Mahmood UA, Hajj G. Excimer Laser Coronary Angioplasty. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563198/
Rawlins J, Din JN, Talwar S, O’Kane P (2016) Coronary intervention with the excimer laser: review of the technology and outcome data. Interv Cardiol (London, England). 11(1):27–32. https://doi.org/10.15420/icr.2016:2:2
doi: 10.15420/icr.2016:2:2
pmcid: 5808483
Chhabra L, Zain MA, Siddiqui WJ. Angioplasty. In: StatPearls. StatPearls Publishing; 2023.
Grundfest WS, Litvack F, Forrester JS, Goldenberg T, Swan HJ, Morgenstern L, Fishbein M, McDermid IS, Rider DM, Pacala TJ (1985) Laser ablation of human atherosclerotic plaque without adjacent tissue injury. J Am Coll Cardiol 5(4):929–933. https://doi.org/10.1016/s0735-1097(85)80435-6
doi: 10.1016/s0735-1097(85)80435-6
pubmed: 3838324
Waller BF (1989) Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters: the future treatment of atherosclerotic coronary artery disease? A clinical-morphological assessment. J Am Coll Cardiol 13:969–987
doi: 10.1016/0735-1097(89)90248-9
pubmed: 2522472
Choy DSJ (1988) History and state-of-the-art of lasers in cardiovascular disease. Laser Med Surg News Adv. 6:34–8
doi: 10.1089/lms.1988.6.3.34
Appelman YE, Piek JJ, Strikwerda S, Tijssen JG, de Feyter PJ, David GK, Serruys PW, Margolis JR, Koelemay MJ, Montauban van Swijndregt EW, Koolen JJ (1996) Randomised trial of excimer laser angioplasty versus balloon angioplasty for treatment of obstructive coronary artery disease. Lancet (London, England). 347(8994):79–84. https://doi.org/10.1016/s0140-6736(96)90209-3
doi: 10.1016/s0140-6736(96)90209-3
pubmed: 8538345
Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J (1997) Randomised comparison of angioplasty of complex coronary lesions at a single center. Excimer laser, rotational atherectomy, and balloon angioplasty comparison (ERBAC) study. Circulation. 96(1):91–98. https://doi.org/10.1161/01.cir.96.1.91
doi: 10.1161/01.cir.96.1.91
pubmed: 9236422
Bittl JA, Ryan TJ Jr, Keaney JF Jr, Tcheng JE, Ellis SG, Isner JM, Sanborn TA (1993) Coronary artery perforation during excimer laser coronary angioplasty. The percutaneous excimer laser coronary angioplasty registry. J Am College Cardiol 21(5):1158–1165. https://doi.org/10.1016/0735-1097(93)90240-2
doi: 10.1016/0735-1097(93)90240-2
Topaz O (1995) Whose fault is it? Notes on “true” versus “pseudo” laser failure. Catheter Cardiovasc Diagn 36(1):1–4. https://doi.org/10.1002/ccd.1810360102
doi: 10.1002/ccd.1810360102
Ting HH, Timimi FK, Bittl JA (1999) Excimer laser angioplasty. Contemporary concepts in cardiology. Developments in cardiovascular medicine, vol 217. Springer, Boston
Litvack F, Eigler N, Margolis J, Rothbaum D, Bresnahan JF, Holmes D, Untereker W, Leon M, Kent K, Pichard A (1994) Percutaneous excimer laser coronary angioplasty: results in the first consecutive 3,000 patients. The ELCA Investigators. J Am Coll Cardiol. 23(2):323–329. https://doi.org/10.1016/0735-1097(94)90414-6
doi: 10.1016/0735-1097(94)90414-6
pubmed: 8294681
Egred M, Brilakis ES (2020) Excimer laser coronary angioplasty (ELCA): fundamentals, mechanism of action, and clinical applications. J Invasive Cardiol 32(2):E27–E35
pubmed: 32005787
McGuff PE, Bushnell D, Soroff HS, Deterling RA Jr (1963) Studies of the surgical applications of laser (light amplification by stimulated emission of radiation). Surg Forum 14:143–145
pubmed: 14064488
Macruz R, Martines JRM, Tupinamba HS et al (1980) Possibilidades terapeuticas do raio laser em ateromas. Arq Bras Cardiol 34:9–13
pubmed: 7406741
Stanek F (2019) Laser angioplasty of peripheral arteries: basic principles, current clinical studies, and future directions. Diagn Interv Radiol 25(5):392–397. https://doi.org/10.5152/dir.2019.18515
doi: 10.5152/dir.2019.18515
pubmed: 31358488
pmcid: 6727821
Khan S, Schofield P (2008) Laser use in percutaneous coronary intervention. In: Norell MS, Perrins J, Meier B, Lincoff AM (eds) Essential Interventional Cardiology, 2nd edn. WB Saunders, Philadelphia, pp 219–230. https://doi.org/10.1016/B978-0-7020-2981-3.50021-0
doi: 10.1016/B978-0-7020-2981-3.50021-0
Litvack F, Eigler NL, Margolis JR, Grundfest WS, Rothbaum D, Linnemeier T, Hestrin LB, Tsoi D, Cook SL, Krauthamer D (1990) Percutaneous excimer laser coronary angioplasty. Am J Cardiol 66(15):1027–1032. https://doi.org/10.1016/0002-9149(90)90499-q
doi: 10.1016/0002-9149(90)90499-q
pubmed: 2220626
Safian RD, Freed M, Lichtenberg A, May MA, Juran N, Grines CL, O’Neill WW (1993) Are residual stenoses after excimer laser angioplasty and coronary atherectomy due to inefficient or small devices? Comparison with balloon angioplasty. J Am Coll Cardiol 22(6):1628–1634. https://doi.org/10.1016/0735-1097(93)90587-q
doi: 10.1016/0735-1097(93)90587-q
pubmed: 8227830
Niccoli G, Giubilato S, Conte M, Belloni F, Cosentino N, Marino M, Mongiardo R, Crea F (2011) Laser for complex coronary lesions: impact of excimer lasers and technical advancements. Int J Cardiol 146(2):296–299. https://doi.org/10.1016/j.ijcard.2010.10.092
doi: 10.1016/j.ijcard.2010.10.092
pubmed: 21126783
Ambrosini V, Sorropago G, Laurenzano E, Golino L, Casafina A, Schiano V, Gabrielli G, Ettori F, Chizzola G, Bernardi G, Spedicato L, Armigliato P, Spampanato C, Furegato M (2015) Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study. Cardiovasc Revascularisation Med: Incl Mol Interv 16(3):141–146. https://doi.org/10.1016/j.carrev.2015.02.002
doi: 10.1016/j.carrev.2015.02.002
Shimojo K, Shibata N, Takagi K et al (2023) Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analysed by nuclear scintigraphy. Int J Cardiovasc Imaging 39(4):831–842. https://doi.org/10.1007/S10554-022-02771-0
doi: 10.1007/S10554-022-02771-0
pubmed: 36508056
Shibata N, Takagi K, Morishima I et al (2020) The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy. Int J Cardiovasc Imaging 36(1):161–170. https://doi.org/10.1007/S10554-019-01690
doi: 10.1007/S10554-019-01690
pubmed: 31451993
Harima A, Sairaku A, Inoue I et al (2018) Real-life experience of a stent-less revascularisation strategy using a combination of excimer laser and drug-coated balloon for patients with acute coronary syndrome. J Interv Cardiol 31(3):284–292. https://doi.org/10.1111/JOIC.12495
doi: 10.1111/JOIC.12495
pubmed: 29464846
Sasaki S, Nakajima K, Watanabe K et al (2022) Integrated backscatter-intravascular ultrasound and modification of plaque during excimer laser coronary angioplasty. Cardiovasc Interv Ther 37(2):354–362. https://doi.org/10.1007/S12928-021-00797-0
doi: 10.1007/S12928-021-00797-0
pubmed: 34333753
Hirose S, Ashikaga T, Hatano Y et al (2016) Treatment of in-stent restenosis with excimer laser coronary angioplasty: benefits over scoring balloon angioplasty alone. Lasers Med Sci 31(8):1691–1696. https://doi.org/10.1007/S10103-016-2039
doi: 10.1007/S10103-016-2039
pubmed: 27516177
Arai T, Tsuchiyama T, Inagaki D, Yoshida K, Fukamizu S (2023) Benefits of excimer laser coronary angioplasty over thrombus aspiration therapy for patients with acute coronary syndrome and thrombolysis in myocardial infarction flow grade 0. Lasers Med Sci 38(1):1–7. https://doi.org/10.1007/S10103-022-03691-0
doi: 10.1007/S10103-022-03691-0