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Laser Atheroablation in Challenging Coronary Lesions

  • Itsik Ben-Dor
  • Ron WaksmanEmail author

Abstract

Excimer laser coronary atherectomy (ELCA) has been used for coronary intervention for more than 20 years for the treatment of obstructed coronary arteries. This technology is designed to ablate the obstructive atherothrombotic plaque. The initial data have failed to show better angiographic, procedural, or clinical outcome results when compared to balloon angioplasty or stenting. Advances in delivery systems for laser energy using the xenon-chlorine pulsed laser catheter deliver higher energy density with lower heat production and have led to better results in terms of efficacy and safety with low complication rate. The Spectranetics CVX-300® (Spectranetics Corporation, Colorado Springs, CO) excimer laser catheter system has been used for the treatment of several coronary indications. This chapter will focus on complex coronary lesions, including balloon-resistant lesions, chronic total occlusions, in-stent restenosis (ISR), and underexpanded stents in calcified lesions. ELCA is used for thrombus containing lesions in acute myocardial infarction and degenerated saphenous vein graft lesions (not discussed in this chapter).

Keywords

Excimer laser coronary atherectomy Complex coronary lesions Calcified coronary lesion Excimer laser atheroablation Balloon-resistant lesion 

References

  1. 1.
    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. Randomised trial of excimer laser angioplasty versus balloon angioplasty for treatment of obstructive coronary artery disease. Lancet. 1996;347:79–84.CrossRefPubMedGoogle Scholar
  2. 2.
    Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J. Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study. Circulation. 1997;96:91–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Bittl JA, Chew DP, Topol EJ, Kong DF, Califf RM. Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty. J Am Coll Cardiol. 2004;43:936–42.CrossRefPubMedGoogle Scholar
  4. 4.
    Köster R, Hamm CW, Seabra-Gomes R, Herrmann G, Sievert H, Macaya C, Fleck E, Fischer K, Bonnier JJ, Fajadet J, Waigand J, Kuck KH, Henry M, Morice MC, Pizzulli L, Webb-Peploe MM, Buchwald AB, Ekström L, Grube E, Al Kasab S, Colombo A, Sanati A, Ernst SM, Haude M, Serruys PW, et al. Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial. The Laser Angioplasty of Restenosed Stents (LARS) Investigators. J Am Coll Cardiol. 1999;34:25–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Giri S, Ito S, Lansky AJ, Mehran R, Margolis J, Gilmore P, Garratt KN, Cummins F, Moses J, Rentrop P, Oesterle S, Power J, Kent KM, Satler LF, Pichard AD, Wu H, Greenberg A, Bucher TA, Kerker W, Abizaid AS, Saucedo J, Leon MB, Popma JJ. Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry. Catheter Cardiovasc Interv. 2001;52:24–34.CrossRefPubMedGoogle Scholar
  6. 6.
    Mehran R, Mintz GS, Satler LF, Pichard AD, Kent KM, Bucher TA, Popma JJ, Leon MB. Treatment of in-stent restenosis with excimer laser coronary angioplasty: mechanisms and results compared with PTCA alone. Circulation. 1997;96:2183–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Köster R, Kähler J, Terres W, Reimers J, Baldus S, Hartig D, Berger J, Meinertz T, Hamm CW. Six-month clinical and angiographic outcome after successful excimer laser angioplasty for in-stent restenosis. J Am Coll Cardiol. 2000;36:69–74.CrossRefPubMedGoogle Scholar
  8. 8.
    Radke PW, Kaiser A, Frost C, Sigwart U. Outcome after treatment of coronary in-stent restenosis; results from a systematic review using meta-analysis techniques. Eur Heart J. 2003;24:266–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Mehran R, Dangas G, Mintz GS, Waksman R, Abizaid A, Satler LF, Pichard AD, Kent KM, Lansky AJ, Stone GW, Leon MB. Treatment of in-stent restenosis with excimer laser coronary angioplasty versus rotational atherectomy: comparative mechanisms and results. Circulation. 2000;101:2484–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Goldberg SL, Colombo A, Akiyama T. Stent under-expansion refractory to balloon dilatation: a novel solution with excimer laser. J Invasive Cardiol. 1998;10:269–73.PubMedGoogle Scholar
  11. 11.
    Lam SC, Bertog S, Sievert H. Excimer laser in management of underexpansion of a newly deployed coronary stent. Catheter Cardiovasc Interv. 2014;83:E64–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Latib A, Takagi K, Chizzola G, Tobis J, Ambrosini V, Niccoli G, Sardella G, DiSalvo ME, Armigliato P, Valgimigli M, Tarsia G, Gabrielli G, Lazar L, Maffeo D, Colombo A. Excimer laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry. Cardiovasc Revasc Med. 2014;15:8–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Ahmed WH, al-Anazi MM, Bittl JA. Excimer laser-facilitated angioplasty for undilatable coronary narrowings. Am J Cardiol. 1996;78:1045–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Bilodeau L, Fretz EB, Taeymans Y, Koolen J, Taylor K, Hilton DJ. Novel use of a high-energy excimer laser catheter for calcified and complex coronary artery lesions. Catheter Cardiovasc Interv. 2004;62:155–61.CrossRefPubMedGoogle Scholar
  15. 15.
    Shen ZJ, García-García HM, Schultz C, van der Ent M, Serruys PW. Crossing of a calcified “balloon uncrossable” coronary chronic total occlusion facilitated by a laser catheter: a case report and review recent four years’ experience at the Thoraxcenter. Int J Cardiol. 2010;145:251–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Fernandez JP, Hobson AR, McKenzie D, Shah N, Sinha MK, Wells TA, Levy TM, Swallow RA, Talwar S, O’Kane PD. 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;9:243–50.CrossRefPubMedGoogle Scholar
  17. 17.
    McKenzie DB, Talwar S, Jokhi PP, O’Kane PD, Osherov A, Strauss B, Dahm J. How should I treat severe coronary artery calcification when it is not possible to dilate a balloon or deliver a RotaWire™? EuroIntervention. 2011;6:779–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Egred M. RASER angioplasty. Catheter Cardiovasc Interv. 2012;79:1009–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Badr S, Ben-Dor I, Dvir D, Barbash IM, Kitabata H, Minha S, Pendyala LK, Loh JP, Torguson R, Pichard AD, Waksman R. The state of the excimer laser for coronary intervention in the drug-eluting stent era. Cardiovasc Revasc Med. 2013;14:93–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Tarsia G, De Michele M, Viceconte N, Takagi K, Biscione C, Del Prete G, Polosa D, Osanna R, Lisanti P. Immediate and midterm follow-up results of excimer laser application in complex percutaneous coronary interventions: report from a single center experience. Interv Med Appl Sci. 2013;5:10–5.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Niccoli G, Giubilato S, Conte M, Belloni F, Cosentino N, Marino M, Mongiardo R, Crea F. Laser for complex coronary lesions: impact of excimer lasers and technical advancements. Int J Cardiol. 2011;146:296–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Serruys PW, Hamburger JN, Koolen JJ, Fajadet J, Haude M, Klues H, Seabra-Gomes R, Corcos T, Hamm C, Pizzuli L, Meier B, Mathey D, Fleck E, Taeymans Y, Melkert R, Teunissen Y, Simon R. Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial. Eur Heart J. 2000;21:1797–805.CrossRefPubMedGoogle Scholar
  23. 23.
    Appelman YE, Koolen JJ, Piek JJ, Redekop WK, de Feyter PJ, Strikwerda S, David GK, Serruys PW, Tijssen JG, van Swijnregt E, Lie KI. Excimer laser angioplasty versus balloon angioplasty in functional and total coronary occlusions. Am J Cardiol. 1996;78:757–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Division of CardiologyWashington Hospital CenterWashingtonUSA

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