ESTABLISHING INTERVENTIONAL TECHNOLOGIES TO TREAT UNDER EXPANDED STENTS: A ROLE FOR EXCIMER CORONARY LASER ATHERECTOMY

Abstract

Objective: To evaluate the efficacy, safety, feasibility and medium termoutcomeof the use of excimer laser coronary atherectomy (ELCA) either alone orcombined with rotational atherectomy (RA) for the management of underexpanded stents.

Methodology: In this case series we collected the procedural details, images,equipment used, complications and follow up details of patients from June 2009to October 2014, who had undergone ELCA PCI for under expanded stents in fourhigh volume UK, PCI centres. The data was analysed for outcome measures.

Results: About 16 patients were included in the study, five patients presentedwith stable angina (31%), three with ACS and in eight it was noted at the indexPCI that there was an under expanded stent. Culprit vessel was LAD (44%), LCX(12.5%), RCA (31%), LMS (6.2%) and venous graft (6.2%). The lesion wasmodified with a 0.9 mm ELCA catheterxcimer laser coronary atherectomy, Rotational atherectomy, Culpritvessel , Stenting.in 14 (87.5%) while in 2 the catheter wasupsized to 2.0 mm. ELCA was performed with saline flush in 12 (75%) andcontrast milieu in 4 (25%) cases. The mean total pulses delivered were11769.9±6950.5 and the maximum fluence was 80 mJ/mm with a repetitionrate of 80 Hz. The mean case time, fluoroscopic time, contrast used, totalradiation and skin radiation was 102.75±57minutes, 23.56±19.46 minutes,200.5±84 ml, 8212.38±7184.9 Gym and 2269.9±1193.6 mGy,respectively. NC balloon was used in all cases after ELCA and double coated NCballoon in 9 cases (56%). Successful laser predilatation was achieved by usingELCA alone in 13 cases while in 3 cases RA was required following ELCA withburr size of 1.25mmand 1.75mm(2 cases). Following modification of the underexpanded stented segment a mean of 1.5±0.6 stents were deployed. The stentlength/diameter pre and post laser PCI was 29±13.07 mm, 3.41±0.66mmand31.7±18.5 mm, 3.7±0.5 mm, respectively. Following ELCA PCI and stenting theMLA increased from 2.93±1.2 mm to 9.49±3.08 mm . No majorcomplications occurred during the intervention.

Conclusion: This case series demonstrates the safety and efficacy of ELCA usedalone or in combination with RA in the treatment of under expanded stents. To ourknowledge this application of the RASER technique for this clinical indication ispresented here for the first time.