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He P, Chen H, Yang J, Gao L, Guo J, Chen Y, Wang Q. Debulking With Excimer Laser Coronary Angioplasty Versus Balloon Angioplasty in Patients With in Stent Restenosis (ELDISR Study): A Randomized Controlled Trial. Lasers Surg Med 2025; 57:329-338. [PMID: 40197645 DOI: 10.1002/lsm.70013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/25/2025] [Accepted: 03/29/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVES Excimer laser coronary angioplasty (ELCA) is a safe and effective method for lesion preparation. However, its impact on clinical outcomes in patients with in-stent restenosis (ISR) undergoing drug-coated balloon (DCB) angioplasty remains unclear. This study aims to evaluate the effect of ELCA-based lesion preparation on the clinical outcomes of ISR patients treated with standard DCB angioplasty. METHODS In this prospective, single-center, randomized controlled trial, patients with ISR were randomized 1:1 to either ELCA (+) or ELCA (-). The ELCA (+) group received ELCA for lesion preparation followed by standard DCB angioplasty, while the ELCA (-) group received standard DCB angioplasty alone. The primary endpoint was the rate of target lesion revascularization (TLR) within 1 year. Safety was also evaluated. RESULTS A total of 110 patients were randomized to either the ELCA (+) group (n = 55) or the ELCA (-) group (n = 55). The mean age of the study participants was 64.5 years, 89 (80.9%) were men and 51 (46.4%) had diabetes mellitus. The procedure was successful in all patients. The primary endpoint event occurred in five patients (cumulative incidence, 9.1%) in the ELCA (+) group and in 13 patients (cumulative incidence, 23.6%) in the ELCA (-) group (HR, 0.38; 95% CI, 0.15-0.95; p = 0.038). CONCLUSIONS Lesion preparation with ELCA before DCB angioplasty is a safe and effective strategy for patients with ISR, associated with a lower incidence of TLR compared to standard DCB angioplasty alone. However, due to the limited sample size and single-center design, these findings should be considered hypothesis-generating. Future validation requires confirmation through multicenter studies with larger patient populations. TRIAL REGISTRATION Unique identifier: ChiCTR2300068962.
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Affiliation(s)
- Pan He
- Department of Cardiology, Yingtan City People's Hospital, Yingtan City, Jiangxi Province, China
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haiwei Chen
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junjie Yang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Gao
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Guo
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Wang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
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Vizzari G, Caminiti R, Ielasi A, Vetta G, Parlavecchio A, Mazzone P, Sacchetta G, Magnocavallo M, Della Rocca DG, Siviglia M, Versace AG, Contarini M, Micari A. Contrast-enhanced excimer laser stepwise approach during PCI for resistant coronary lesions. Catheter Cardiovasc Interv 2024; 104:220-226. [PMID: 38959377 DOI: 10.1002/ccd.31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/06/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power. AIM To evaluate the effectiveness and safety of the contrast-enhanced ELCA by a stepwise approach in the treatment of RCLs. METHODS We retrospectively examined consecutive patients undergoing contrast-enhanced ELCA-assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in-stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. RESULTS We enrolled 114 patients who underwent contrast-enhanced ELCA-assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in-stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast-enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively). CONCLUSIONS The contrast-enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in-stent-resistant coronary lesions.
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Affiliation(s)
- Giampiero Vizzari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Paolo Mazzone
- Cardiology Unit, Ospedale"Umberto I", Siracusa, Italy
| | | | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Massimo Siviglia
- Interventional Cardiology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | | | - Antonio Micari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
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He P, Chen H, Yang J, Gao L, Guo J, Chen Y, Wang Q. Excimer laser coronary angioplasty combined with drug-coated balloon in the treatment of in-stent restenosis. Lasers Surg Med 2024; 56:474-484. [PMID: 38738401 DOI: 10.1002/lsm.23794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/22/2024] [Accepted: 04/21/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons (DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA. METHODS We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention). RESULTS A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval, CI: 0.57-1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11-0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001). CONCLUSIONS The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.
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Affiliation(s)
- Pan He
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Haiwei Chen
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junjie Yang
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Gao
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Guo
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yundai Chen
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Wang
- Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
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Case BC, Bazarbashi N, Johnson A, Rogers T, Ben-Dor I, Satler LF, Waksman R, Hashim HD, Gallino R, Bernardo NL. A novel approach to saline/contrast delivery in excimer laser coronary atherectomy (ELCA) to enhance efficacy: MAXCon ELCA technique. Catheter Cardiovasc Interv 2024; 103:917-923. [PMID: 38605682 DOI: 10.1002/ccd.31037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
The advent of excimer laser coronary atherectomy (ELCA) nearly four decades ago heralded a novel way to treat complex lesions, both coronary and peripheral, which were previously untraversable and thus untreatable. These complex lesions include heavily calcified lesions, ostial lesions, bifurcation lesions, chronic total occlusions, in-stent restenosis (including stent underexpansion), and degenerative saphenous vein grafts. We discuss the technology of ELCA, its indications, applications, and complications, and suggest the "MAXCon ELCA" technique for better outcomes without increased risk. Lastly, we present a case of MAXCon ELCA effectively treating a complex lesion.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Najdat Bazarbashi
- Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Adam Johnson
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hayder D Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Robert Gallino
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Liang S, Yang J, Ma M, Zhou M, Liu Z, Huang H, He Y. Restenosis after excimer laser coronary atherectomy and drug-coated balloon dilation in Takayasu's arteritis: a case report and review of the literature. Thromb J 2023; 21:87. [PMID: 37563604 PMCID: PMC10413599 DOI: 10.1186/s12959-023-00529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
Takayasu's arteritis (TAK) is a rare chronic granulomatous arteritis that mainly affects the aorta and its major branches. Coronary artery (CA) involvement can be observed in 10-25% of TAK patients. We report a 21-year-old young female who was previously diagnosed with TAK and severe left main coronary artery (LMCA) stenosis and underwent numerous percutaneous coronary interventions (PCIs) in our hospital due to in-stent restenosis (ISR). This time, an excimer laser coronary atherectomy (ELCA) and drug-coated balloon (DCB) dilation was taken at the LMCA for the ISR. The blood flow was smooth after the operation, and she was symptom-free after discharge. Unfortunately, 5 months later, severe intimal hyperplasia was still seen in the stent of LMCA and left anterior descending (LAD) coronary artery. A coronary artery bypass graft surgery (CABG) was performed, and she has been symptom-free ever since. ELCA plus DCB is one of the novel ways we first reported. However, ensuring long-term inflammation control is equally important to restore blood flow. The combination of revascularization and anti-inflammation/immunosuppression is recommended to improve the outcomes of TAK patients with CA involvements.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Jinming Yang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Minggang Zhou
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
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Li J, Shang C, Rong Y, Sun J, Cheng Y, He B, Wang Z, Li M, Ma J, Fu B, Ji X. Review on Laser Technology in Intravascular Imaging and Treatment. Aging Dis 2022; 13:246-266. [PMID: 35111372 PMCID: PMC8782552 DOI: 10.14336/ad.2021.0711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 12/14/2022] Open
Abstract
Blood vessels are one of the most essential organs, which nourish all tissues in our body. Once there are intravascular plaques or vascular occlusion, other organs and circulatory systems will not work properly. Therefore, it is necessary to detect abnormal blood vessels by intravascular imaging technologies for subsequent vascular treatment. The emergence of lasers and fiber optics promotes the development of intravascular imaging and treatment. Laser imaging techniques can obtain deep vascular images owing to light scattering and absorption properties. Moreover, photothermal and photomechanical effects of laser make it possible to treat vascular diseases accurately. In this review, we present the research progress and applications of laser techniques in intravascular imaging and treatment. Firstly, we introduce intravascular optical coherent tomography and intravascular photoacoustic imaging, which can obtain various information of plaques. Multimodal intravascular imaging techniques provide more information about intravascular plaques, which have an essential influence on intravascular imaging. Secondly, two laser techniques including laser angioplasty and endovenous laser ablation are discussed for the treatment of arterial and venous diseases, respectively. Finally, the outlook of laser techniques in blood vessels, as well as the integration of laser imaging and treatment are prospected in the section of discussions.
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Affiliation(s)
- Jing Li
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
| | - Ce Shang
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
| | - Yao Rong
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
- Medical Engineering Devices of Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Jingxuan Sun
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
| | - Yuan Cheng
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
| | - Boqu He
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
| | - Zihao Wang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
| | - Ming Li
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Jianguo Ma
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
| | - Bo Fu
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China.
- Key Laboratory of Big Data-Based Precision Medicine Ministry of Industry and Information Technology, Interdisciplinary Innovation Institute of Medicine and Engineering, Beihang University, Beijing, China.
| | - Xunming Ji
- BUAA-CCMU Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China.
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
- Neurosurgery Department of Xuanwu Hospital, Capital Medical University, Beijing, China.
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Exciter laser coronary atherectomy (ELCA) can be a powerful weapon in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hou FJ, Ma XT, Zhou YJ, Guan J. Excimer laser coronary atherectomy for a severe calcified coronary ostium lesion: A case report. World J Clin Cases 2021; 9:10666-10670. [PMID: 35004999 PMCID: PMC8686135 DOI: 10.12998/wjcc.v9.i34.10666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention can be challenging for ostial coronary artery lesions due to calcium burden and elastic fiber content. Excimer laser coronary atherectomy (ELCA) is a less common treatment for severe calcified coronary ostium lesions.
CASE SUMMARY An 81-year-old male presented to the Cardiology Department of Qingdao Municipal Hospital with a 1-year history of chest pain. Coronary angiography showed severe calcific stenosis (approximately 90%) in the right coronary artery ostium. The right coronary artery ostium was unable to be advanced using a 2.5 mm × 12.0 mm balloon (NC Sprinter, Medtronic, United States) or dilated using a 2.0 mm × 12.0 mm balloon (Sprinter, Medtronic, United States). The patient underwent successful ELCA and balloon dilation of the calcified coronary ostium lesion.
CONCLUSION ELCA appears to be a safe and effective treatment for the management of severe calcified coronary ostium lesions.
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Affiliation(s)
- Fang-Jie Hou
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266000, Shandong Province, China
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiao-Teng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jun Guan
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao 266000, Shandong Province, China
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Masuda R, Shibui T, Mizunuma Y, Yoshikawa S, Takeda K, Kujiraoka H, Yamaoka K, Arai T, Inagaki D, Kimura T, Yoshida K, Takahashi M, Kitamura T, Hojo R, Tsuchiyama T, Fukamizu S, Sasano T. Impact of small diameter and low level of emission laser coronary atherectomy in patients with acute myocardial infarction. Lasers Med Sci 2021; 37:1567-1573. [PMID: 34436695 PMCID: PMC8971151 DOI: 10.1007/s10103-021-03405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
Excimer laser coronary atherectomy (ELCA) is an effective treatment to remove intracoronary thrombi. In the present study, we compared in-hospital mortality in patients with acute myocardial infarction (AMI) who underwent conventional treatment and conventional treatment plus ELCA. Among 656 patients who were admitted to our hospital through the Tokyo CCU Network, 104 patients with AMI who were treated by percutaneous coronary intervention between January 2013 and December 2016 met inclusions criteria and underwent conventional treatment with ELCA (ELCA group) and 89 underwent conventional treatment alone (conventional group). We retrospectively evaluated in-hospital mortality within 30 days and used propensity score (PS) matching to reduce assignment bias and multivariate analysis to detect the predictors of in-hospital mortality. In-hospital mortality rate was significantly lower in the ELCA group before and after PS matching (2.9% vs. 13.5%, p = 0.006 before PS matching, and 2.8% vs. 14.1%, p = 0.016 after PS matching). After PS matching, β-blocker or statins use, incidence of shock, Killip classification, and door-to-balloon time were not significantly different. A multivariate logistic regression analysis identified ELCA, dyslipidemia, shock, and left ventricular ejection fraction as independent predictors of in-hospital mortality (odds ratio (OR), 0.147, 95% confidence interval [CI], 0.022–0.959, p = 0.045; OR, 0.077, 95% CI, 0.007–0.805, p = 0.032; OR, 6.494, 95% CI, 1.228–34.34, p = 0.028; OR, 0.890, 95% CI, 0.828–0.957, p = 0.002, respectively). Our data indicate that ELCA with the small diameter and low level emission may reduce the in-hospital mortality compared to conventional methods in patients with AMI in drug-eluting stent era.
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Affiliation(s)
- Ryo Masuda
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan.
| | - Takashi Shibui
- Department of Cardiology, Toshima Hospital in the Tokyo Metropolitan Health and Hospitals Corporation, 33-1, Sakaecho, Itabashi, Tokyo, 173-0015, Japan
| | - Yoshiaki Mizunuma
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Shogo Yoshikawa
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Kosuke Takeda
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Hirofumi Kujiraoka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Koichiro Yamaoka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takashi Kimura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Kiyotaka Yoshida
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Masao Takahashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Takaaki Tsuchiyama
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya, Tokyo, 150-0013, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University Hospital, 5-45, Yushima 1-Chome, Bunkyo, Tokyo, 113-8519, Japan
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