Laser atherectomy

Laser atherectomy

Laser atherectomy is a novel technique useful in in-stent restenosis, stent under expansion, balloon uncrossable lesions and chronic total occlusions [1]. An important advantage of excimer laser atherectomy over other atherectomy devices is delivery on a standard 0.014-inch guidewire [2]. The technique can be mastered after a short period of training.

Major limitation is the presence of heavy calcification, which requires rotational atherectomy for clearance. But when there is inability to pass a rota wire, laser may be useful in creating an upstream channel to permit rota wire passage.

Laser device works by producing monochromatic light energy to cause heat and shock waves which lead to disruption of plaque and thrombus.

A large report on 1,471 laser cases from the British Cardiovascular Intervention Society database which constituted 0.21% cases out of 686,358 PCI procedures has been published [3]. The data was collected for procedures between 2006 and 2016. Higher odds were noted for dissection, perforation and slow flow. Though the chance of acute procedural complication with laser were higher, it did not increase the likelihood of in-hospital major adverse cardiac/cerebrovascular events (MACCE) or its individual components (death, peri-procedural MI, stroke and major bleed).

Another interesting information from the same database is regarding RASER, the combined use of rotational atherectomy and excimer laser coronary atherectomy [4]. RASER was employed in 153 cases, which was 0.02% of the cases in the database over the ten year period. Results were similar to the main report. Increased rates of induction of shock, slow flow and arterial complications were observed in this study. But RASER did not increase the likelihood of in-hospital MACCE, major bleeding or death.

References

1. Tsutsui RS, Sammour Y, Kalra A, Reed G, Krishnaswamy A, Ellis S, Nair R, Khatri J, Kapadia S, Puri R. Excimer Laser Atherectomy in Percutaneous Coronary Intervention: A Contemporary Review. Cardiovasc Revasc Med. 2021 Apr;25:75-85.
2. Rawlins J, Din JN, Talwar S, O’Kane P. Coronary Intervention with the Excimer Laser: Review of the Technology and Outcome Data. Interv Cardiol. 2016 May;11(1):27-32.
3. Protty MB, Hussain HI, Gallagher S, Al-Raisi S, Aldalati O, Farooq V, Sharp ASP, Egred M, O’Kane P, Ludman P, Anderson RA, Mamas MA, Kinnaird T. Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv. 2021 Apr 1;97(5):E653-E660.
4. Protty MB, Gallagher S, Farooq V, Sharp ASP, Egred M, O’Kane P, Kinnaird T. Combined use of rotational and excimer lASER coronary atherectomy (RASER) during complex coronary angioplasty-An analysis of cases (2006-2016) from the British Cardiovascular Intervention Society database. Catheter Cardiovasc Interv. 2021 Jun 1;97(7):E911-E918.