Key result
ELCA after prior thoracic radiotherapy links to multiple coronary perforations requiring covered stents.
Why the study?
Management of heavily calcified coronary lesions remains challenging despite advances in plaque-modifying technologies.
Case Report (n=1)
Excimer laser coronary angioplasty in patients with prior thoracic radiotherapy may carry an increased risk of coronary perforation due to radiation-related vessel wall remodeling.
BACKGROUND: Management of heavily calcified coronary lesions remains challenging despite advances in plaque-modifying technologies. Excimer laser coronary angioplasty (ELCA) is an effective adjunctive strategy with a low risk of no-reflow. CASE SUMMARY: A 75-year-old woman with non-ST-segment elevation acute coronary syndrome and severe left ventricular dysfunction, previously treated with thoracic radiotherapy, underwent percutaneous coronary intervention of a calcified left anterior descending artery lesion. Optical coherence tomography revealed an eruptive calcified nodule with thrombus and a concentric stenosis. ELCA was selected to minimize distal embolization; however, the procedure was complicated by multiple coronary perforations requiring covered stent implantation. DISCUSSION: This case suggests that coronary perforation during ELCA may result from the interplay between lesion complexity, procedural factors, and radiation-related vessel wall remodeling.
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Sparasci et al. (2026) conducted a case report in Non-ST-segment elevation acute coronary syndrome (n=1). Excimer laser coronary angioplasty (ELCA) was evaluated. Excimer laser coronary angioplasty in a patient with prior thoracic radiotherapy was complicated by multiple coronary perforations requiring covered stent implantation.
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