Excimer laser coronary atherectomy-assisted percutaneous coronary intervention in complex coronary artery lesions: an early Indian experience

Background: Excimer laser coronary atherectomy (ELCA) to modify or debulk atherosclerotic plaque during percutaneous coronary intervention (PCI) has been in clinical use for the past four decades. Primarily, ELCA was introduced to mitigate the challenges posed by routine PCI for complex lesions and in crossing resistant lesions. Aims: The aim of the present study was to evaluate the efficacy and safety of ELCA in complex coronary lesions. Methods: This study included 71 consecutive patients who underwent treatment with ELCA-assisted PCI for complex coronary lesions. The data were analysed for the incidence of procedural success and related complications with major adverse cardiovascular outcomes at baseline, post-procedure, 1-month and 6-month follow-up. Results: The study included 71 real-world patients with highly complex lesion subsets, comprising uncrossable chronic total occlusions (CTOs; 26 [33.77%]), moderately to heavily calcified lesions (33 [42.86%]), long diffused in-stent restenosis (ISR) lesions (30 [38.96%]), and ST-segment elevation myocardial infarction with a large thrombus burden (27 [35.06%]). The study population was predominantly male (87.32%), including 71 individuals with a mean age of 63.51±13.57 years. The mean left ventricular ejection fraction (LVEF) was 45.1±11.6%; however, 15 patients (21.13%) had an LVEF of <30%. A total of 31 (43.66%) patients had a SYNTAX score of >22. The direct use of maximum energy as a default setting was used in 52 patients (85.3%) and was not associated with any procedural or patient complications. No major adverse cardiac events (MACE) were reported during hospitalisation. The cumulative procedural success rate was 100%, and the device success rate was 96.10%. The 6-month incidence of MACE was significantly low at 2 (2.82%) and was attributed to target vessel revascularisations only. Conclusions: In this study, ELCA was observed to be an effective and safe device, making it a suitable alternative strategy for complex PCI in patients with difficult-to-cross lesions such as CTO, ISR, heavily thrombotic lesions, and calcified lesions. In difficult-to-cross lesions, even when the ELCA device failed to advance across, the delivered ELCA energy modified the lesion sufficiently to render it crossable. There were no safety concerns despite the direct use of maximum energy as a default strategy in this study population.