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.

Sign in to read and download the full article

Forgot your password?
No account yet? Sign up for free!
Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

Read next article
Effect of stenting on the near-infrared spectroscopy-derived lipid core burden index of carotid artery plaque