Excimer Laser Coronary Angioplasty

Transcript of the video: Conventional balloon angioplasty enlarges the vessel a bit as well as plasters the plaque on to the vessel wall, while laser angioplasty is a new technique, also known as laser atherectomy, in which excimer laser, which is a monochromatic source of light, is used to vaporize the plaque or thrombus by producing heat and shock waves. The most important advantage of laser angioplasty or excimer laser angioplasty, is that you need only a standard guidwire, 0.014 inch standard guide wire, unlike the other atherectomy devices which require a bulkier guidewire.

Diagrammatic representation of laser angioplasty or atherectomy. This is the catheter which gives the laser beam. It is introduced over a standard guidewire, 0.014 inch standard guidewire.

These are the situations in which a laser angioplasty or excimer laser atherectomy can be considered. One is in-stent restenosis. Stent under expansion. This is probably another interesting aspect, when there are ballloon uncrossable lesions, you can drill a hole to produce a path for passing the guidewire and balloon. Chronic total occlusions.

Now, the major limitation for excimer laser angioplasty is when there is heavy calcification. In presence of heavy calcification, it requires rotational atherectomy for clearance of calcification. But when there is an inability to pass a rota wire, even in the presence of heavy calcification, laser may be useful in creating an upstream channel to permit the use of rota wire. Rota wire is bulkier than the laser angioplasty guidewire. So, in order to use a rota, you require a laser angioplasty sometimes to drill a hole.

That brings us to an additional new term known as RASER angioplasty, sometimes called for combination of laser with rotational atherectomy. Combined debulking technique for treating heavily calcified coronary artery lesions and severe calcified, undilatable coronary artery lesions that were unresponsive to either of the techniques alone, a combination of both LASER and atherectomy, that is rotational high speed rotational atherectomy has been done and it has been called sometimes as RASER angioplasty.

When you combine two procedures, there is of course there is an increased rate of induction of shock, slow flow and arterial complications. But, RASER did not increase the likelihood of in-hospital Major Adverse Cardiac and Cerebral Events and major bleeding or death. Incidentally, these are also the important disadvantages of laser angioplasty as well. Induction of shock, slow flow and arterial complications are more than for other PCI procedures. But, still they also did not increase MACCE, major bleeding or death when a large database of the British Cardiovascular Interventional Society was analyzed and published in 2021, which had nearly 1500 cases of laser angioplasty and about 150 cases of RASER angioplasty.