AI Article Synopsis

  • The study analyzed the success and complications of using excimer laser coronary atherectomy (ELCA) in patients experiencing balloon failure during percutaneous coronary intervention (PCI), with a focus on chronic total occlusions (CTO).
  • Out of 58 identified balloon failure cases treated with ELCA, the overall procedure success rate was 91%, with ELCA used alone or in combination with rotational atherectomy (RA) showing favorable outcomes.
  • The findings suggest that ELCA is a safe and effective option for treating difficult lesions in PCI, although there were some complications, including a serious incident leading to mortality.

Article Abstract

Aims: To establish success and complication rates of excimer laser coronary atherectomy (ELCA) in a contemporary series of patients with balloon failure during percutaneous coronary intervention (PCI) of both chronic total occlusions (CTO) and lesions with distal TIMI 3 flow.

Methods And Results: We identified 58 cases of balloon failure treated with ELCA±rotational atherectomy (RA) over four years, representing 0.84% of all PCI performed in our centre during this period. Balloon failures were classified according to: (i) mechanism of balloon failure; and (ii) whether this occurred in the context of treating a CTO. ELCA was performed following balloon failure using the CVX-300 Excimer Laser System and a 0.9 mm catheter with saline flush. For the entire cohort, procedure success was achieved in 91% (with ELCA successful: alone in 76.1%, after RA failure in 6.8% and in combination with RA for 8.6%). Only in one case did RA succeed where ELCA had failed. There were four procedure-related complications, including transient no-reflow, side branch occlusion and two coronary perforations, of which one was directly attributable to ELCA and led to subsequent mortality.

Conclusions: ELCA provides safe and effective adjunctive therapy in contemporary PCI to treat lesions associated with balloon failure due to an inability either to cross the lesion or to expand a balloon sufficiently to permit stenting. ELCA was successful in the majority of these selected cases when used independently with further effectiveness achieved when combined with RA or after RA failure.

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Source
http://dx.doi.org/10.4244/EIJV9I2A40DOI Listing

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