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Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital

BACKGROUND: Excimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the small...

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Autores principales: Jawad-Ul-Qamar, Muhammad, Sharma, Harish, Vetrugno, Vincenzo, Sandhu, Kully, Ludman, Peter F, Doshi, Sagar N, Townend, Jonathan N, Osheiba, Mohammed, Zaphiriou, Alex, Khan, Sohail Q
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055138/
https://www.ncbi.nlm.nih.gov/pubmed/33863837
http://dx.doi.org/10.1136/openhrt-2020-001522
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author Jawad-Ul-Qamar, Muhammad
Sharma, Harish
Vetrugno, Vincenzo
Sandhu, Kully
Ludman, Peter F
Doshi, Sagar N
Townend, Jonathan N
Osheiba, Mohammed
Zaphiriou, Alex
Khan, Sohail Q
author_facet Jawad-Ul-Qamar, Muhammad
Sharma, Harish
Vetrugno, Vincenzo
Sandhu, Kully
Ludman, Peter F
Doshi, Sagar N
Townend, Jonathan N
Osheiba, Mohammed
Zaphiriou, Alex
Khan, Sohail Q
author_sort Jawad-Ul-Qamar, Muhammad
collection PubMed
description BACKGROUND: Excimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the smaller 0.9 mm laser catheter. As the coronary complexity has increased, there has been a renewed interest in the ELCA. This study investigates the indications, procedural characteristics, complications and outcomes of ELCA in a contemporary coronary interventional practice. METHODS: This single-centre study retrospectively analysed 50 patients treated with ELCA between January 2013 and January 2019. RESULTS: Patients had a mean age of 67.9±11.4 years with a male predominance (65.3%). 25 (50%) cases were performed in patients with stable angina. Failure to deliver the smallest available balloon/microcatheter was the most frequent indication in 32 (64%) cases for ELCA use. 30 (60%) of the procedures were performed via radial access. The 0.9 mm X-80 catheter was used in 41 (82%) of cases, delivering on average 9000±3929 pulses. ELCA-related complications included 2 coronary dissections and 1 perforation, all of which were covered with stents. No major complications could be directly attributed to the use of ELCA. There was one death and one case of stent thrombosis within 30 days of the procedure. CONCLUSION: ELCA can be performed safely via the radial approach with a 0.9 mm catheter with a high success rate by suitably trained operators. The low procedure-related complications with contemporary techniques make this a very useful tool for complex coronary interventions, especially for difficult to dilate lesions and chronic total occlusion vessels.
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spelling pubmed-80551382021-04-28 Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital Jawad-Ul-Qamar, Muhammad Sharma, Harish Vetrugno, Vincenzo Sandhu, Kully Ludman, Peter F Doshi, Sagar N Townend, Jonathan N Osheiba, Mohammed Zaphiriou, Alex Khan, Sohail Q Open Heart Interventional Cardiology BACKGROUND: Excimer laser coronary atherectomy (ELCA) can be used as an adjunctive percutaneous coronary intervention treatment for challenging, heavily calcified lesions. Although previous studies have documented high rates of complication and restenosis, these predate the introduction of the smaller 0.9 mm laser catheter. As the coronary complexity has increased, there has been a renewed interest in the ELCA. This study investigates the indications, procedural characteristics, complications and outcomes of ELCA in a contemporary coronary interventional practice. METHODS: This single-centre study retrospectively analysed 50 patients treated with ELCA between January 2013 and January 2019. RESULTS: Patients had a mean age of 67.9±11.4 years with a male predominance (65.3%). 25 (50%) cases were performed in patients with stable angina. Failure to deliver the smallest available balloon/microcatheter was the most frequent indication in 32 (64%) cases for ELCA use. 30 (60%) of the procedures were performed via radial access. The 0.9 mm X-80 catheter was used in 41 (82%) of cases, delivering on average 9000±3929 pulses. ELCA-related complications included 2 coronary dissections and 1 perforation, all of which were covered with stents. No major complications could be directly attributed to the use of ELCA. There was one death and one case of stent thrombosis within 30 days of the procedure. CONCLUSION: ELCA can be performed safely via the radial approach with a 0.9 mm catheter with a high success rate by suitably trained operators. The low procedure-related complications with contemporary techniques make this a very useful tool for complex coronary interventions, especially for difficult to dilate lesions and chronic total occlusion vessels. BMJ Publishing Group 2021-04-16 /pmc/articles/PMC8055138/ /pubmed/33863837 http://dx.doi.org/10.1136/openhrt-2020-001522 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Interventional Cardiology
Jawad-Ul-Qamar, Muhammad
Sharma, Harish
Vetrugno, Vincenzo
Sandhu, Kully
Ludman, Peter F
Doshi, Sagar N
Townend, Jonathan N
Osheiba, Mohammed
Zaphiriou, Alex
Khan, Sohail Q
Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title_full Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title_fullStr Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title_full_unstemmed Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title_short Contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
title_sort contemporary use of excimer laser in percutaneous coronary intervention with indications, procedural characteristics, complications and outcomes in a university teaching hospital
topic Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055138/
https://www.ncbi.nlm.nih.gov/pubmed/33863837
http://dx.doi.org/10.1136/openhrt-2020-001522
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