Clinical Outcomes of Percutaneous Coronary Intervention Using Excimer Laser Coronary Atherectomy for Complex Coronary Lesions: The ACCELERATE Registry

BACKGROUND: Excimer laser coronary atherectomy (ELCA) is a technology used to treat a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic total occlusions, stent under-expansion, and stent restenosis. AIMS AND METHODS: This prospective multicenter observational study aims at examining procedural, in-hospital and long-term clinical outcomes in a consecutive cohort of patients treated with ELCA for complex coronary lesions. The primary end point was the rate of procedural success, defined as PCI success plus the absence of in-hospital MACE. RESULTS: From July 2018 to May 2024 a total of 320 consecutive patients (age 71 ± 9 years) with 429 lesions treated with ELCA were enrolled. The most common clinical presentation was chronic coronary syndrome (48%), and the left anterior descending artery was the target vessel in 47% of cases. The subsets of lesions treated were stent restenosis (48%), de novo lesions (46%), and stent underexpansion (6%). Procedural success was achieved in 97% of patients. In-hospital MACE occurred in 1.2% of cases, mainly driven by death (0.9%) and no reflow (0.9%). After multivariate analysis, left ventricular function was recognized as independent predictor of procedural failure (OR 0.9, 95% CI 0.84-0.97, p = 0.006). During a median clinical follow-up of 841 days (interquartile range: 395-1414) the survival free from MACE was 94.7%. Death was 2.9%, MI 1.5%, TLR 3.4%, and the composite was 4.7%. CONCLUSION: ELCA demonstrates a high rate of angiographic and clinical success in treating complex coronary lesions in a real-world cohort of high-risk patients.