The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography

EuroIntervention 2019;15:e279-e288. DOI: 10.4244/EIJ-D-18-00139

1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 2. Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; 3. St. Francis Hospital-The Heart Center, Roslyn, NY, USA

Aims: We aimed to evaluate the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent underexpansion as assessed by optical coherence tomography (OCT).

Methods and results: We studied 81 patients (81 lesions with ISR, stent underexpansion, and peri-stent calcium >90°) who underwent OCT imaging both pre and post percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs. without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA: 61%, non-ELCA: 12%, p<0.01), larger final minimum lumen area (ELCA: 4.76 mm2 [3.25, 5.57], non-ELCA: 3.46 mm2 [2.80, 4.13], p<0.01), and a larger previously implanted stent area (ELCA: 6.15 mm2 [4.83, 7.09], non-ELCA: 4.65 mm2 [3.84, 5.40], p<0.01). In the multivariable model, ELCA use was associated with peri-stent calcium fracture (odds ratio 46.5, 95% confidence interval: 6.8, 315.9, p<0.001) that, in turn, was associated with final larger lumen and stent dimensions. Finally, contrast injection during ELCA was associated with multiple calcium fractures and fractures even in thicker calcium.

Conclusions: ELCA is effective for treating ISR with underexpansion by disrupting peri-stent calcium, facilitating better expansion of the previously implanted stent.

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