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Excimer laser coronary angioplasty

Tetsumin Lee, Richard A Shlofmitz, Lei Song, Theofanis Tsiamtsiouris, Thomas Pappas, Antonio Madrid, Allen Jeremias, Elizabeth S Haag, Ziad A Ali, Jeffery W Moses, Mitsuaki Matsumura, Gary S Mintz, Akiko Maehara
AIMS: We evaluated the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent under-expansion as assessed by optical coherence tomography (OCT). METHODS AND RESULTS: We studied 81 patients (81 lesions with ISR, stent under-expansion, and peri-stent calcium >90°) who underwent OCT imaging both pre- and post-percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs without ELCA (n=58)...
May 15, 2018: EuroIntervention
Ayako Harima, Akinori Sairaku, Ichiro Inoue, Kenji Nishioka, Toshiharu Oka, Yasuharu Nakama, Kazuoki Dai, Kuniomi Ohi, Haruki Hashimoto, Yasuki Kihara
OBJECTIVES: We aimed to test a novel stent-less revascularization strategy using a combination of excimer laser coronary angioplasty (ELCA) and drug-coated balloon (DCB) for patients with acute coronary syndrome (ACS). BACKGROUND: Percutaneous coronary intervention with drug eluting stents is a standard invasive treatment for ACS. Some unsolved issues however remain, such as stent thrombosis and bleeding risks associated with dual antiplatelet therapy. METHODS: Consecutive ACS patients were planned to receive either a DCB application following ELCA without a stent implantation or conventional revascularization with a coronary stent...
February 20, 2018: Journal of Interventional Cardiology
Yoshihiro Imai, Takehiro Yamashita, On Topaz
RATIONALE: Thin-cap fibroatheroma (TCFA) and red thrombus are suggested as a high-risk of embolic complications during percutaneous coronary intervention (PCI). Intracoronary aspiration procedures occasionally result in either an insufficient thrombus removal or provide no significant effects on TCFA. PATIENT CONCERNS: A 76-year-old male underwent coronary angiography for chest pain. DIAGNOSES: Coronary angiography revealed a tight stenosis at the right coronary artery which resulted in treatment by PCI...
October 2017: Medicine (Baltimore)
Antonio Mangieri, Richard J Jabbour, Akihito Tanaka, Andrea Aurelio, Antonio Colombo, Azeem Latib
: Excimer coronary laser atherectomy (ECLA) has been shown to be both well tolerated and effective for plaque modification. Its technology is based on ultraviolet energy and is capable of disintegrating atheroma, without burning or grossly fragmenting it. ELCA has proven effective in the percutaneous treatment of a variety of complex lesions. Here we present a case of multiple heavy calcified lesions successfully prepared with ELCA and finally treated with the implantation of multiple bioresorbable scaffolds...
December 2016: Journal of Cardiovascular Medicine
Sho Hashimoto, Akihiko Takahashi, Takeshi Yamada, Yukio Mizuguchi, Norimasa Taniguchi, Shunsuke Nakajima, Tetsuya Hata
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
Luca A Ferri, Richard J Jabbour, Francesco Giannini, Susanna Benincasa, Marco Ancona, Damiano Regazzoli, Antonio Mangieri, Matteo Montorfano, Antonio Colombo, Azeem Latib
OBJECTIVES: Coronary stent underexpansion is a known risk factor for in-stent restenosis and stent thrombosis. There are limited options once noncompliant balloons have failed to achieve optimal stent expansion. Excimer Laser Coronary Angioplasty with contrast medium injection is one possibility, but not readily available. Rotational atherectomy is an alternative, and has been described in case reports, but concerns exist regarding safety. METHODS: All consecutive patients undergoing rotational atherectomy for symptomatic in-stent restenosis due to stent underexpansion resistant to noncompliant balloon postdilatation between January 2005 and December 2015 were analysed...
November 10, 2016: Catheterization and Cardiovascular Interventions
Shunsuke Hirose, Takashi Ashikaga, Yu Hatano, Shunji Yoshikawa, Taro Sasaoka, Yasuhiro Maejima, Mitsuaki Isobe
Treatment of in-stent restenosis (ISR) is associated with a high incidence of recurrence. This study evaluated the clinical safety and 6-month efficacy of excimer laser coronary angioplasty (ELCA) before scoring balloon dilatation for the treatment of ISR. Twenty-three patients with ISR were included and treatment strategy of ISR was dependent on each operator. Twelve patients among those were treated with ELCA before scoring balloon dilatation (ELCA group) and 11 patients were treated with scoring balloon alone (non-ELCA group)...
November 2016: Lasers in Medical Science
Vittorio Ambrosini, Giovanni Sorropago, Eugenio Laurenzano, Luca Golino, Alfredo Casafina, Vittorio Schiano, Gabriele Gabrielli, Federica Ettori, Giuliano Chizzola, Guglielmo Bernardi, Leonardo Spedicato, Pietro Armigliato, Carmine Spampanato, Martina Furegato
AIM: An innovative xenon-chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. METHODS AND RESULTS: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%)...
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Takashi Ashikaga, Shunji Yoshikawa, Mitsuaki Isobe
Stent underexpansion is known as a major cause of restenosis and stent thrombosis in calcified coronary lesions. We report a case of calcified nodule pretreated with excimer laser coronary angioplasty (ELCA) in acute coronary syndrome (ACS). Excimer laser use altered underlying lesion morphology such as calcified nodule and accompanied plaque and thrombus. Pretreatment of ELCA may be a useful tool to get a full expansion of the deployed stent without distal embolism for calcified nodule in ACS.
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Azeem Latib, Kensuke Takagi, Giuliano Chizzola, Jonathan Tobis, Vittorio Ambrosini, Giampaolo Niccoli, Gennaro Sardella, Maria Elena DiSalvo, Pietro Armigliato, Marco Valgimigli, Giandomenico Tarsia, Gabriele Gabrielli, Lawrence Lazar, Diego Maffeo, Antonio Colombo
BACKGROUND/OBJECTIVES: Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective. METHODS AND RESULTS: ECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent...
January 2014: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Giampaolo Niccoli, Flavia Belloni, Nicola Cosentino, Francesco Fracassi, Elena Falcioni, Marco Roberto, Roberta Antonazzo Panico, Rocco Mongiardo, Italo Porto, Antonio Maria Leone, Francesco Burzotta, Carlo Trani, Filippo Crea
Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non-ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24)...
November 15, 2013: American Journal of Cardiology
Francesco Fracassi, Marco Roberto, Giampaolo Niccoli
Excimer laser utilization as an adjunctive device for percutaneous coronary intervention has increased in the last few years. Many technical advancements have led to better results in terms of efficacy and safety with a low complication rate. In particular, excimer laser for thrombus-containing lesions is able to achieve rapid thrombus removal and plaque debulking along with subsequent facilitation of stent angioplasty and a low rate of microvascular obstruction. Other indications for laser angioplasty embrace in-stent restenosis, chronic total occlusions, saphenous vein graft lesions and new potential applications, such as stent expansion optimization and bifurcation lesions...
July 2013: Expert Review of Medical Devices
Simon Cheung Chi Lam, Stefan Bertog, Horst Sievert
We report the successful management of underexpansion of a newly deployed coronary stent refractory to balloon dilatations. Direct stenting was performed for a lesion in the mid left anterior descending artery (without angiographically apparent heavy coronary calcification). The stent remained underexpanded despite repeated balloon dilatations including with high-pressure inflations. Subsequently, an excimer laser catheter was used in an attempt to vaporize the plaque by the accoustomechanical effect of the rapidly exploding bubbles...
January 1, 2014: Catheterization and Cardiovascular Interventions
Daisuke Shishikura, Satoru Otsuji, Shin Takiuchi, Atsushi Fukumoto, Katsuaki Asano, Masashi Ikushima, Tokuki Yasuda, Katsuyuki Hasegawa, Toshikazu Kashiyama, Masanori Yabuki, Toshiaki Hanafusa, Yorihiko Higashino
BACKGROUND:  Mechanical reperfusion has proven to be an unquestionably superior treatment strategy over that of thrombolytic therapy in patients with acute coronary syndrome (ACS). Excimer laser coronary angioplasty (ELCA) is a unique revascularization device that has a lytic effect on thrombus, in addition to its debulking effect on the atherosclerotic plaque beneath the thrombus. METHODS AND RESULTS:  This single-center retrospective analysis consisted of consecutive ACS patients treated with ELCA (n=50) and age- and sex-matched ACS patients treated with manual aspiration (n=48) without use of a distal protection device...
2013: Circulation Journal: Official Journal of the Japanese Circulation Society
Salem Badr, Itsik Ben-Dor, Danny Dvir, Israel M Barbash, Hironori Kitabata, Sa'ar Minha, Lakshmana K Pendyala, Joshua P Loh, Rebecca Torguson, Augusto D Pichard, Ron Waksman
OBJECTIVES: This study aims to determine how excimer laser coronary atherectomy (ELCA) performs in the drug-eluting stent (DES) era. BACKGROUND: For more than 20 years, ELCA has been used for coronary intervention. With developments in the coronary intervention field, the role of ELCA is in question. METHODS: The study includes 119 patients with 124 lesions who underwent percutaneous coronary intervention (PCI) with ELCA in our institution from January 2004 to May 2011...
March 2013: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Nicolas W Shammas, Gail A Shammas, Alexander Hafez, Ryan Kelly, Emily Reynolds, Andrew N Shammas
BACKGROUND: Treatment of in-stent restenosis of the femoropopliteal (FP) arteries is challenging with a high rate of restenosis. Excimer laser atherectomy (ELA) has a theoretical advantage of ablating restenotic tissue and reducing or delaying the need for repeat revascularization. We present a retrospective analysis from our center on the outcomes of ELA in the treatment of in-stent restenosis of the FP arteries. METHODS: Demographic, clinical, angiographic and procedural data were collected on all patients that underwent ELA for in-stent restenosis from February 2005 to April 2010 at a single medical center...
November 2012: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Masami Nishino, Yasuharu Lee, Daisuke Nakamura, Takahiro Yoshimura, Masayuki Taniike, Nobuhiko Makino, Hiroyasu Kato, Yasuyuki Egami, Ryu Shutta, Jun Tanouchi, Yoshio Yamada
AIM: In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA)...
October 2012: Journal of Invasive Cardiology
Mohaned Egred
The novel approach of using excimer laser in a contrast medium for treating an under-expanded stent in a calcified coronary artery is described. In this first reported case, the laser in a contrast medium was used to treat an under-expanded stent deployed 18 months prior in a calcified non-dilatable coronary artery lesion. The normal laser approach in saline medium flush during lasing to clear any contrast was not effective. The use of concurrent contrast during lasing was effective and successful to help expand the stent with a successful outcome...
August 2012: Journal of Invasive Cardiology
Steven G Friedman
Harnessing light energy in the form of lasers became possible after the discovery of electricity. Scientists found various uses for lasers beginning in the 1960s. Creating large amounts of pulsed UV light with any device, including a laser, remained difficult until excimer lasers were invented in the following decade. The invention of excimer lasers coincided with the advent of balloon angioplasty, leading physicians to speculate about using laser energy to obliterate obstructing arterial lesions. The first report of laser energy to vaporize an atherosclerotic plaque appeared in 1980...
December 2011: Surgical Technology International
György Fogarassy, Dezső Apró, Gábor Veress
Coronary artery perforation is a rare, but particularly feared and sometimes life-threatening, complication of percutaneous coronary interventions. The incidence of coronary perforation has increased with newer, more invasive interventional devices and techniques like rotablation, excimer laser coronary angioplasty, routine high-pressure balloon dilatation, or chronic total occlusion interventions. Here we describe a case of Ellis grade 2 perforation following a balloon dilatation performed in an in-stent restenotic total occlusion...
April 2012: Journal of Invasive Cardiology
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