Vivek Kodoth, Omar Rana, Nalyaka Sambu, Karim Ratib, Paul Johnston, Adrian Large, Jim Nolan, Adam Debelder, Jehangir Din, Suneel Talwar, Peter O`kane.
Establishing interventional technologies to treat under expanded stents: a role for excimer coronary laser atherectomy.
Pak Heart J Jan ;51(1):82-5.

Objective: To evaluate the efficacy, safety, feasibility and medium term outcome of the use of excimer laser coronary atherectomy (ELCA) either alone or combined with rotational atherectomy (RA) for the management of under expanded stents. Methodology: In this case series we collected the procedural details, images,equipment used, complications and follow up details of patients from June 2009 to October 2014, who had undergone ELCA PCI for under expanded stents in four high volume UK, PCI centres. The data was analysed for outcome measures. Results: About 16 patients were included in the study, five patients presented with stable angina (31%), three with ACS and in eight it was noted at the index PCI that there was an under expanded stent. Culprit vessel was LAD (44%), LCX(12.5%), RCA (31%), LMS (6.2%) and venous graft (6.2%). The lesion was modified with a 0.9 mm ELCA catheter excimer laser coronary atherectomy, Rotational atherectomy, Culprit vessel , Stenting in 14 (87.5%) while in 2 the catheter was upsized to 2.0 mm. ELCA was performed with saline flush in 12 (75%) and contrast milieu in 4 (25%) cases. The mean total pulses delivered were 11769.9+-6950.5 and the maximum fluence was 80 mJ/mm with a repetitionrate of 80 Hz. The mean case time, fluoroscopic time, contrast used, total radiation and skin radiation was 102.75+-57 minutes, 23.56+-19.46 minutes,200.5+-84 ml, 8212.38+-7184.9 Gym and 2269.9+-1193.6 mGy,respectively. NC balloon was used in all cases after ELCA and double coated NC balloon in 9 cases (56%). Successful laser predilatation was achieved by using ELCA alone in 13 cases while in 3 cases RA was required following ELCA with burr size of 1.25mm and 1.75mm (2 cases). Following modification of the under expanded stented segment a mean of 1.5+-0.6 stents were deployed. The stent length / diameter pre and post laser PCI was 29+-13.07 mm, 3.41+-0.66mm and 31.7+-18.5 mm, 3.7+-0.5 mm, respectively. Following ELCA PCI and stenting the MLA increased from 2.93+-1.2 mm to 9.49+-3.08 mm . No major complications occurred during the intervention. Conclusion: This case series demonstrates the safety and efficacy of ELCA used alone or in combination with RA in the treatment of under expanded stents. To our knowledge this application of the RASER technique for this clinical indication is presented here for the first time.

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