Excimer laser coronary atherectomy for uncrossable coronary lesions. A multicenter registry

Soledad Ojeda, Lorenzo Azzalini, Javier Suárez de Lezo, Gurpreet S. Johal, Rafael González, Nitin Barman, Francisco Hidalgo, Neus Bellera, George Dangas, Alfonso Jurado-Román, Annapoorna Kini, Miguel Romero, Raúl Moreno, Bruno Garcia del Blanco, Roxana Mehran, Samin K. Sharma, Manuel Pan

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Objectives: To assess the efficacy and safety of excimer laser coronary atherectomy (ELCA), as well as, the long-term outcomes and the factors associated with ELCA failure in uncrossable lesions. Background: Uncrossable lesions constitute a challenge for percutaneous coronary intervention. Methods: This multicenter registry included 126 patients with 126 uncrossable lesions. Study endpoints were ELCA success, technical success and a composite of cardiac death, myocardial infarction (MI), and target-lesion revascularization (TLR) on follow-up. Predictors of ELCA failure were analyzed. Results: Moderate or severe calcification was present in 79 (62.7%) of the lesions and 58 (46%) were a chronic total occlusion. ELCA success was obtained in 103 (81.8%) patients. Rotational atherectomy was attempted as bailout in 21 out of 23 ELCA failure (91.3%), being successful in 14 (66.7%) of them. Finally, technical and procedural success were achieved in 114 (90.5%) and 110 (87.3%) of the patients. Severe calcification was independently associated with ELCA failure (OR: 3.73, 95% CI: 1.35–10.32; p =.011). Two (1.6%) patients died (one after a stroke and another patient because of heart failure), 4 (3.2%) developed a non-Q MI without clinical consequences and 1 (0.8%) patient had a Q-MI. Other complications were ventricular tachycardia/fibrillation (n = 2; 1.6%) and flow-limiting dissection (n = 1, 0.8%). At follow-up (median 424 days), 3 (2.4%) patients died (1 (0.8%) from cardiovascular cause) and 15 (11.9%) required TLR. Conclusions: In our multicenter experience, ELCA use demonstrated to be safe and reasonably effective with a rate of events on follow-up relatively low. Severe calcification was associated with ELCA failure.

Original languageEnglish
Pages (from-to)1241-1249
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume98
Issue number7
DOIs
StatePublished - 1 Dec 2021

Keywords

  • calcification
  • coronary chronic total occlusion
  • laser
  • percutaneous coronary intervention

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