TY - JOUR
T1 - Excimer laser coronary angioplasty (ELCA)
T2 - Fundamentals, mechanism of action, and clinical applications
AU - Egred, Mohaned
AU - Brilakis, Emmanouil S.
N1 - Funding Information:
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Egred is a proctor for ELCA and reports honoraria and speaker fees from Philips, Abbott Vascular, Boston Scientific, Vascular Perspectives, Biosensors, Biotronik, and AstraZeneca. Dr Brilakis reports consulting/speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, InfraRedx, GE Healthcare, Siemens, Teleflex, and Medtronic; research support from Siemens, Regeneron, and Osprey; shareholder in MHI Ventures.
Publisher Copyright:
© 2020 HMP Communications. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Laser coronary angioplasty was developed to modify atherosclerotic plaque and help with the acute and longer-term limitations of balloon angioplasty, namely, intimal dissection and restenosis, respectively. Excimer laser debulks and modifies the tissue with its photochemical, photothermal, and photokinetic properties without causing significant injury. With important refinements and advancements, laser has gained a renewed place in treating complex and resistant coronary lesions after a disappointing start. When used in line with the instructions, laser is an important tool that allows the completion of difficult and complicated cases. It is a useful tool in the catheterization laboratory to treat lesions that are uncrossable or undilatable. Laser is also helpful in cases where a stent was deployed but remains under-expanded, with accumulating evidence of its efficacy in such cases. In addition, laser is increasingly used for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to facilitate modification of the proximal CTO cap to allow penetration with a wire and completion of the procedure. Laser has been used in certain circumstances by experienced operators with simultaneous contrast rather than saline injection, to increase its effect and allow the successful completion of complex PCIs. This article outlines the scientific background, experimental data, practical procedural techniques, and clinical applications of excimer laser coronary angioplasty in the treatment of coronary artery disease.
AB - Laser coronary angioplasty was developed to modify atherosclerotic plaque and help with the acute and longer-term limitations of balloon angioplasty, namely, intimal dissection and restenosis, respectively. Excimer laser debulks and modifies the tissue with its photochemical, photothermal, and photokinetic properties without causing significant injury. With important refinements and advancements, laser has gained a renewed place in treating complex and resistant coronary lesions after a disappointing start. When used in line with the instructions, laser is an important tool that allows the completion of difficult and complicated cases. It is a useful tool in the catheterization laboratory to treat lesions that are uncrossable or undilatable. Laser is also helpful in cases where a stent was deployed but remains under-expanded, with accumulating evidence of its efficacy in such cases. In addition, laser is increasingly used for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) to facilitate modification of the proximal CTO cap to allow penetration with a wire and completion of the procedure. Laser has been used in certain circumstances by experienced operators with simultaneous contrast rather than saline injection, to increase its effect and allow the successful completion of complex PCIs. This article outlines the scientific background, experimental data, practical procedural techniques, and clinical applications of excimer laser coronary angioplasty in the treatment of coronary artery disease.
KW - CTO
KW - Complex coronary disease
KW - ELCA
KW - Laser angioplasty
KW - PCI
KW - Percutaneous coronary intervention
KW - Resistant coronary lesions
KW - Uncrossable lesions
KW - Undilatable lesions
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M3 - Article
C2 - 32005787
AN - SCOPUS:85078858719
SN - 1042-3931
VL - 33
SP - E27-E35
JO - Journal of Invasive Cardiology
JF - Journal of Invasive Cardiology
IS - 2
ER -