P524Angiographic outcomes after the combined use of paclitaxel-coated balloon and excimer laser coronary angioplasty for drug-eluting stent in-stent restenosis

Abstract Background Drug-eluting stent restenosis (DES-ISR) is associated with poorer outcomes than those of bare-metal stent restenosis after treatment with paclitaxel-coated balloon (PCB), and late restenosis after PCB angioplasty for DES-ISR is a residual problem. Excimer laser coronary angioplasty (ELCA) is thought to be advantageous for ISR treatment by removing neointima. However, whether the combination of ELCA and PCB angioplasty is more effective than the use of PCB only angioplasty in DES-ISR has not been studied so far. Purpose We evaluated the efficacy of ELCA and PCB combination therapy for DES-ISR at mid-and late-term after revascularization. Methods From January 2014 to March 2016, 166 DES-ISR lesions were treated with ELCA and no-ELCA prior to PCB. Two serial angiographic follow-ups were planned for the patients (at 6–12 and 18–24 months after procedure). Acute procedural and follow-up angiographic results were assessed by quantitative coronary angiography. ELCA and no-ELCA group included 74 lesions and 92 lesions, respectively. Results There was no significant difference between the two groups in the clinical characteristics except the prevalence of hemodialysis, the rate of first-generation DES (37.9% vs 36.8%, p=0.897), previous stent size (2.90±0.39 mm vs 2.77±0.39 mm, p=0.063), and reference vessel diameter (2.65±0.46 mm vs 2.60±0.65 mm, p=0.593). Early follow-up angiography was performed in 66 lesions (89.1%) of ELCA group, and was done in 76 lesions (82.6%) of no-ELCA group. In the ELCA group, percentage diameter stenosis (%DS) just after procedure and at 6–12 months later were significantly smaller than those of no-ELCA group. Besides, target lesion revascularization (TLR) rate at 6–12 months after procedure was tended to be lower in the ELCA group. Late follow-up angiography was performed for 93 lesions (81.6%) of the remaining 114 lesions (excluding TLR lesion), late restenosis was found 9 lesions (18.6%) in the ELCA group and 11 lesions (24.4%) in the no-ELCA group (p=0.504). Late luminal loss was similar in both groups (0.37±0.71 mm vs 0.24±0.82 mm, p=0.438), and %DS at 12–18 months after revascularization was not different between the two groups. Changes of %DS and TLR rate Conclusions %DS in the ELCA group was smaller at just after procedure and the advantage was kept even after 1-year. However, late restenosis and TLR at 2-year after revascularization for DES-ISR could not be reduced by ELCA and PCB combination therapy.

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TCT-800 Long-term Target Lesion Revascularization After Treatment With Excimer Laser Coronary Atherectomy for In-Stent Restenosis of Drug-Eluting Stent

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.09.1010 ◽

2017 ◽

Vol 70 (18) ◽

pp. B325 ◽

Cited By ~ 1

Author(s):

Eiji Ichimoto ◽

Tadayuki Kadohira ◽

Takashi Nakayama ◽

Joseph De Gregorio

Keyword(s):

Excimer Laser ◽

Target Lesion ◽

Target Lesion Revascularization ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Clinical Follow-up of Excimer Laser Coronary Angioplasty for In-stent Restenosis

Korean Circulation Journal ◽

10.4070/kcj.1999.29.9.891 ◽

1999 ◽

Vol 29 (9) ◽

pp. 891

Author(s):

Jin Ok Jeong ◽

Hyeon Cheol Gwon ◽

Sung Uk Kwon ◽

Sung Yun Lee ◽

Kyung Ju Ahn ◽

...

Keyword(s):

Excimer Laser ◽

Coronary Angioplasty ◽

Stent Restenosis ◽

In Stent Restenosis ◽

Excimer Laser Coronary Angioplasty

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Excimer Laser Coronary Angioplasty (ELCA) for Diffuse In-stent Restenosis: Beneficial Long-term Results after Sufficient Debulking with a Lesion-specific Approach using various Laser Catheters

Lasers in Medical Science ◽

10.1007/pl00011347 ◽

2001 ◽

Vol 16 (2) ◽

pp. 84-89 ◽

Cited By ~ 11

Author(s):

J.B. Dahm

Keyword(s):

Excimer Laser ◽

Coronary Angioplasty ◽

Long Term Results ◽

Specific Approach ◽

Stent Restenosis ◽

In Stent Restenosis ◽

Excimer Laser Coronary Angioplasty

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Clinical and angiographic profile of symptomatic patients undergoing percutaneous transluminal coronary angioplasty and drug-eluting stent implantation

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20194316 ◽

2019 ◽

Vol 7 (10) ◽

pp. 3819

Author(s):

V.S.R. Bhupal ◽

P. Sampath Kumar

Keyword(s):

Coronary Angioplasty ◽

Tertiary Care ◽

Percutaneous Transluminal Coronary Angioplasty ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

Paclitaxel Group ◽

Drug Eluting ◽

Transluminal Coronary Angioplasty ◽

Percutaneous Transluminal ◽

In Stent Restenosis

Background: There are limited number of studies in India which have looked at this clinical and angiographic characteristic of the disease. Thus, this study was conducted to assess the clinical and angiographic profile of symptomatic patients who underwent percutaneous transluminal coronary angioplasty (PTCA) and drug-eluting stent (DES) implantation.Methods: This was an observational study conducted at a tertiary-care center in India between November 2014 and November 2015. A total of 106 consecutive patients who received either Cypher/Xience/BioMime stent presented with anginal symptoms were included in the study. Based on the type of stent received, patients were divided into two groups: (A) Limus group; (B) Paclitaxel group. Coronary angiogram was done in all the patients. Angioplasty data were collected from patient records. Angiographic profiles of the two groups were compared and analysed.Results: Among the 106 patients, 54 patients were included in the Limus group and 52 patients were included in the Taxus stent. De novo lesions were found to be significantly higher in the Limus group (40(74%), p = 0.06) whereas the in-stent restenosis was found to be significantly higher in the paclitaxel group (22(42.3%), p = 0.08). At follow-up, the incidence of death was 0% and no patients suffered by myocardial infarction. One (1.8%), two (3.8%) patients from the Limus and Paclitaxel groups had target vessel revascularization, respectively.Conclusions: Development of lesions in new areas rather than in-stent restenosis is the cause for angina in the majority of patients who underwent angioplasty presenting with anginal symptoms.

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Excimer Laser Coronary Angioplasty: Clinical Applications and Procedural Outcome, in a Large-Volume Tertiary Centre

Cardiology ◽

10.1159/000513142 ◽

2021 ◽

pp. 1-7

Author(s):

Conor McQuillan ◽

Mohamed Farag ◽

Mohaned Egred

Keyword(s):

Excimer Laser ◽

Coronary Angioplasty ◽

High Volume ◽

Stent Insertion ◽

Ageing Population ◽

Chronic Total Occlusions ◽

Tertiary Centre ◽

Stent Restenosis ◽

In Stent Restenosis ◽

Excimer Laser Coronary Angioplasty

Excimer-laser coronary angioplasty can be used to modify undilatable and uncrossable lesions in native arteries and in-stent restenosis which are increasingly encountered with the ageing population undergoing coronary intervention. We present our laser experience over a 10-year period in a large cardiac tertiary centre. Method: Retrospective analysis of prospectively collected data on all procedures where laser was used from August 2008 to December 2019. Clinical presentation, demographics, and procedural details were all recorded. Successful procedures were defined as <30% stenosis at the end. Periprocedural and in-hospital complications were recorded and verified. Results are presented as numbers and percentages. Results: A total of 331 patients were identified with 473 lesions treated with laser and an overall total of 637 lesions. Of the 473 lesions treated, 46 (9.9%) were in-stent restenosis, 146 (30.9%) were chronic total occlusions, and the rest were uncrossable or undilatable lesions. The vast majority of procedures (97.0%) were performed with the 0.9-mm laser catheter. The overall success rate was 81.6% (58–87%) from low- to high-volume user. Complications included dissection 3 (0.6%), no-reflow 3 (0.6%), coronary perforation 13 (2.7%), and tamponade in 1 (0.2%). Only 3 (0.6%) of the perforations were seen after the laser catheter passage, the rest were seen later following balloon preparation or stent insertion. Conclusion: Laser is a valuable tool for treating complex and resistant coronary lesions. Its efficacy and safety are well established and when applied appropriately, it helps to achieve optimal outcomes for our patients.

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