Skip to main content
SpringerLink
Log in

Trans Radial Excimer Laser Coronary Atherectomy Application During Complex PCI

  • Chapter
  • First Online:
Transradial Approach for Percutaneous Interventions

  • 812 Accesses

Abstract

Lasers were first introduced for the treatment of vascular atherosclerosis in the 1980’s, initially for the treatment of critical limb ischaemia, with subsequent trials that supported its use in the coronary circulation. However, first generation catheters and technique were rudimentary, and were associated with significant complications. Catheter technology development and safer lasing techniques consequently led to significant improvement in clinical outcomes and an increase in uptake amongst interventional cardiologists. Simultaneously this has occurred over a period of change in the vascular access landscape for coronary intervention with adaptation from transfemoral to transradial approach and modification of some techniques to treat complex lesion subsets have evolved. This chapter describes the current indications for the use of Excimer Laser atherectomy in modern interventional practice, which is by default now considered from the transradial approach.A detailed description of the ELCA technique and its potential pitfalls has been illustrated with complex interventional cases performed exclusively from the radial artery. This technology provides a solution to a variety of problems that may be encountered, including massive intra-coronary thrombus, uncrossable lesions including chronic total occlusions and when confronted with stent under expansion. Careful case selection, proper utilization of the laser equipment and incorporation of a safe, efficacious lasing technique play a crucial role in successful laser interventions and ensuring optimal patient outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Choy DSJ. History and state-of-the-art of lasers in cardiovascular disease. Laser Med Surg News Adv. 1988:34–8.

    Google Scholar 

  2. Cook SI, Eigler NL, Shefer A, et al. Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty. Circulation. 1991;84:632–43.

    Article  CAS  PubMed  Google Scholar 

  3. Koster R, Kahler J, Brockhoff C, Munzel T, Meinhurtz T. Laser coronary angioplasty: history, present and future. Am J Cardiovasc Drugs. 2002;2(3):197–207.

    Article  PubMed  Google Scholar 

  4. Bittl JA, Sanborn TA, Tcheng JE. Clinical success, complications and restenosis rates with excimer laser coronary angioplasty. Am J Cardiol. 1992;70:1553–9.

    Article  Google Scholar 

  5. Geschwind HJ, Dubois-Rande JL, Zelinsky R, et al. Percutaneous coronary mid-infrared laser angioplasty. Am Heart J. 1991;122:552–8.

    Article  CAS  PubMed  Google Scholar 

  6. Bittl JA, Ryan TJ, Keaney JF. Coronary artery perforation during excimer laser coronary angioplasty. J Am Coll Cardiol. 1993;21:1158–65.

    Article  CAS  PubMed  Google Scholar 

  7. Topaz O. Whose fault is it? Notes on “true” versus “pseudo” laser failure. Editorial. Cathet Cardiovasc Diagn. 1995;36:1–4.

    Article  CAS  PubMed  Google Scholar 

  8. Taylor K, Reiser C. Large eccentric laser angioplasty catheter. In proceedings of lasers in surgery: advanced characterization, therapeutics and systems. SPIE. 1997;2970:34–41.

    Google Scholar 

  9. Tcheng JE. Saline infusion in excimer laser coronary angioplasty. Semin Interv Cardiol. 1996;1:135–41.

    CAS  PubMed  Google Scholar 

  10. Topaz O. A new safer lasing technique for laser facilitated coronary angioplasty. J Interv Cardiol. 1993;6:297–306.

    Article  CAS  PubMed  Google Scholar 

  11. Topaz O. Coronary laser angioplasty. In: Topol EJ, editor. Textbook of interventional cardiology. Philadelphia: WB Saunders Company; 1995. p. 235–55.

    Google Scholar 

  12. Topaz O, Safian RD. Excimer laser coronary angioplasty. In: Safian RD, Freed MS, editors. Manual of interventional cardiology. 3rd ed. Royal Oaks: Physicians Press; 2001. p. 681–91.

    Google Scholar 

  13. Baumbach A, Haase KK, Rose C, Oberhoff M, Hanke H, Karsch KR. Formation of pressure waves during in vitro excimer laser irradiation in whole blood and the effect of dilution with contrast media and saline. Lasers Surg Med. 1994;14:3–6.

    Article  CAS  PubMed  Google Scholar 

  14. Tcheng JE, Wells LD, Phillips HR, Deckelbaum LI, Golobic RA. Development of a new technique for reducing pressure pulse generation during 308-nm excimer laser coronary angioplasty. Cathet Cardiovasc Diagn. 1995;34:15–22.

    Article  CAS  PubMed  Google Scholar 

  15. Deckelbaum LI, Natarajan MK, Bittl JA, Rohlfs K, Scott J, Chisholm R, Bowman KA, Strauss BH. Effect of intracoronary saline infusion on dissection during excimer laser coronary angioplasty: a randomized trial. The percutaneous excimer laser coronary angioplasty (PELCA) investigators. J Am Coll Cardiol. 1995;26:1264–9.

    Article  CAS  PubMed  Google Scholar 

  16. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619.

    Article  Google Scholar 

  17. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol. 2013;61:e78–140.

    Google Scholar 

  18. Karrowni W, Vyas A, Giacomino, B, Schweizer M, Blevins A, Girotra S, Horwitiz P. Radial versus femoral access for primary percutaneous interventions in ST-Segment elevation myocardial infarction patients a meta-analysis of randomized controlled trials. JACC Cardiovascular Interventions. 2013;6(8):814–23.

    Google Scholar 

  19. Dahm JB, Topaz O, Woenckhaus C, et al. laser facilitated thrombectomy: a new therapeutic option for treatment of thrombus–laden coronary lesions. Catheter Cardiovasc Interv. 2002;56:365–72.

    Article  PubMed  Google Scholar 

  20. Topaz O, Minisi AJ, Morris C, Mohanty PK, Carr Jr ME. Photoacoustic fibrinolysis: pulsed-wave, mid infrared laser-clot interaction. J Thromb Thrombolysis. 1996;3:209–14.

    CAS  PubMed  Google Scholar 

  21. Topaz O, Minisi AJ, Bernardo NL, McPherson RA, Martin E, Carr SL, Carr Jr ME. Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet ”phenomenon. Thromb Haemost. 2001;86:1087–93.

    CAS  PubMed  Google Scholar 

  22. Topaz O, Bernardo NL, Shah R, et al. Effectiveness of excimer laser coronary angioplasty in acute myocardial infarction or in unstable angina pectoris. Am J Cardiol. 2001;87:849–55.

    Article  CAS  PubMed  Google Scholar 

  23. Topaz O, Ebersole D, Das T, Alderman EL, Madyoon H, Vora K, Baker JD, Hilton D, Dahm JB. Excimer laser angioplasty in acute myocardial infarction [the CARMEL multicenter study]. Am J Cardiol. 2004;93:694–701.

    Article  PubMed  Google Scholar 

  24. Topaz O, Shah R, Mohanty PK, McQueen RA, Janin Y, Bernardo NL. Application of excimer laser angioplasty in acute myocardial infarction. Lasers Surg Med. 2001;29:185–92.

    Article  CAS  PubMed  Google Scholar 

  25. Niccoli G, Belloni F, Cosentino N, Fracassi F, Falcioni E, Roberto M, Panico RA, Mongiardo R, Porto I, Leone AM, Burzotta F, Trani C, Crea F. Case-control registry of excimer laser coronary angioplasty versus distal protection devices in patients with acute coronary syndromes due to saphenous vein graft disease. Am J Cardiol. 2013;112(10):1586–91.

    Article  PubMed  Google Scholar 

  26. Shishikura D, Otsuji S, Takiuchi S, Fukumoto A, Asano K, Ikushima M, Yasuda T, Hasegawa K, Kashiyama T, Yabuki M, Hanafusa T, Higashino Y. Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome. Circ J. 2013;77(6):1445–52.

    Article  PubMed  Google Scholar 

  27. Dorr M, Vogelgesang D, Hummel A, et al. Excimer laser thrombus elimination for prevention of distal embolisation and no-reflow in patients with acute ST elevation myocardial infarction: results from the randomised LaserAMI study. Int J Cardiol. 2007;116:20–6.

    Article  PubMed  Google Scholar 

  28. Bittl JA. Clinical results with excimer laser coronary angioplasty. Semin Interv Cardiol. 1996;1:129–34.

    CAS  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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 inflate a balloon or deliver a RotaWire? EuroIntervention. 2011;6(6):779–83.

    Article  PubMed  Google Scholar 

  31. 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(2):243–50.

    Article  PubMed  Google Scholar 

  32. Werner GS, Schofer J, Sievert H, Kugler C, Reifart NJ. Multicentre experience with the BridgePoint devices to facilitate recanalisation of chronic total coronary occlusions through controlled subintimal re-entry. EuroIntervention. 2011;7:192–200.

    Article  PubMed  Google Scholar 

  33. Joyal D, Thompson CA, Grantham JA, Buller CE, Rinfret S. The retrograde technique for recanalization of chronic total occlusions: a step-by-step approach. JACC Cardiovasc Interv. 2012;5:1–11.

    Article  PubMed  Google Scholar 

  34. Topaz O. Laser for total occlusion recanalization. In: Waksman R, Saito S, editors. Chronic total occlusions: a guide to recalization. West Sussex: Blackwell Publishing; 2009.

    Google Scholar 

  35. Holmes Jr DR, Forrester JS, Litvack F, et al. Chronic total obstructions and short term outcome: the excimer laser angioplasty registry experience. Mayo Clin Proc. 1993;68:5–10.

    Article  PubMed  Google Scholar 

  36. Papaioannou T, Yadegar D, Vari S, Shehada R, Grundfest WS. Excimer laser (308 nm) recanalisation of in-stent restenosis: thermal considerations. Lasers Med Sci. 2001;16:90–100.

    Article  CAS  PubMed  Google Scholar 

  37. Burris N, Lippincott RA, Elfe A, Tcheng JE, O’Shea JC, Reiser C. Effects of 308 nanometer excimer laser energy on 316 L stainless-steel stents: implications for laser atherectomy of in-stent restenosis. J Invasive Cardiol. 2000;12:555–9.

    CAS  PubMed  Google Scholar 

  38. Lam SC, Bertog S, Sievert H. Excimer laser in management of under expansion of a newly deployed coronary stent. Catheter Cardiovasc Interv. 2014;83:E64–8.

    Article  PubMed  Google Scholar 

  39. Sunew J, Chandwaney RH, Stein DW, et al. Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent. Catheter Cardiovasc Interv. 2001;53:513–7.

    Article  CAS  PubMed  Google Scholar 

  40. 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(1):8–12.

    Article  PubMed  Google Scholar 

  41. Egred M. A novel approach for under-expanded stent: excimer laser in contrast medium. J Invasive Cardiol. 2012;24(8):E161–3.

    PubMed  Google Scholar 

  42. Dangas GD, Claessen BE, Caixeta A, Sanidas EA, Mintz GS, Mehran R. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol. 2010;56:1897–907.

    Article  PubMed  Google Scholar 

  43. Mehran R, Mintz GS, Satler LF, et al. Treatment of in-stent restenosis with excimer laser coronary angioplasty: mechanisms and results compared with PTCA alone. Circulation. 1997;96:2183–9.

    Article  CAS  PubMed  Google Scholar 

  44. Webb JG, Carere RG, Virmani R, et al. Retrieval and analysis of particulate debris after saphenous vein graft intervention. J Am Coll Cardiol. 1999;34:468–75.

    Article  CAS  PubMed  Google Scholar 

  45. Baim DS, Wahr D, George B, et al. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation. 2002;105:1285–90.

    Article  PubMed  Google Scholar 

  46. Bittl JA, Sanborn TA, Yardley DE, et al. Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry. Am J Cardiol. 1994;74:144–8.

    Article  CAS  PubMed  Google Scholar 

  47. Giugliano GR, Falcone MW, Mego D, et al. A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis: the COronary graft Results following Atherectomy with Laser (CORAL) trial. Cardiovasc Revasc Med. 2012;13:84–9.

    Article  PubMed  Google Scholar 

  48. Ebersole D, Dahm JB, Das T, et al. Excimer laser revascularization of saphenous vein grafts in acute myocardial infarction. J Invasive Cardiol. 2004;16:177–80.

    PubMed  Google Scholar 

  49. Rawlins J, Talwar S, Green M, O’Kane P. Optical coherance tomography following percutaneous coronary intervention with excimer laser coronary atherectomy. Cardiovasc Revasc Med. 2014;15(1):29–34.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dorset Heart Centre Royal Bournemouth Hospital Bournemouth, Dors, Bournemouth, UK

    John Rawlins BSc, MBBS, MRCP, MD, Jehangir Din MBBS, MRCP, MD & Suneel Talwar MBBS, MRCP, MD

  2. Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, Dorset, BH7 7DW, UK

    Peter O’Kane BSc, MBBS, FRCP, MD(Res)

Authors
  1. John Rawlins BSc, MBBS, MRCP, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jehangir Din MBBS, MRCP, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suneel Talwar MBBS, MRCP, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter O’Kane BSc, MBBS, FRCP, MD(Res)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter O’Kane BSc, MBBS, FRCP, MD(Res) .

Editor information

Editors and Affiliations

  1. Beijing, China

    Yujie Zhou

  2. Amsterdam, The Netherlands

    Ferdinand Kiemeneij

  3. Kanagawa, Japan

    Shigeru Saito

  4. Beijing Anzhen Hospital, Beijing, China

    Wei Liu

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Rawlins, J., Din, J., Talwar, S., O’Kane, P. (2017). Trans Radial Excimer Laser Coronary Atherectomy Application During Complex PCI. In: Zhou, Y., Kiemeneij, F., Saito, S., Liu, W. (eds) Transradial Approach for Percutaneous Interventions. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7350-8_24

Download citation

  • DOI: https://doi.org/10.1007/978-94-017-7350-8_24

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-017-7349-2

  • Online ISBN: 978-94-017-7350-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation