The mechanism and prognosis of vessel perforation following excimer laser coronary angioplasty in the new generation laser catheter era

Introduction

Excimer laser coronary angioplasty (ELCA) was developed with the aim of improving the outcome of conventional balloon angioplasty [1]; therefore, its original target was limited to a very specific subset of lesions, such as saphenous vein graft, total occlusions, calcified lesions, ostial lesions, lesions greater than 20 mm in length, and balloon dilation failures [2–4]. However, an excimer laser, which can vaporize thrombus, suppress platelet aggregation, and ablate the underlying plaque, has recently been shown to be effective in patients with acute coronary syndrome (ACS) [5]. Although rare, vessel perforation is the most terrible complication of ELCA. Early studies regarding the complications of ELCA in its introductory era revealed that patients with vessel perforation were mainly treated via coronary artery bypass grafting (CABG) [6]; however, the necessity of CABG is decreasing as a result of technological advances, as well as improvements in intervention technique. Therefore, the prognosis of patients who were successfully treated for vessel perforation via ELCA without CABG is not fully addressed. Also, the risk factors related to ELCA-induced vessel perforation in the era of a new indication, ACS, and a new generation excimer laser catheter are unknown.

Aim

The purpose of this study was to investigate the current prognosis and mechanism of vessel perforation as induced by ELCA.

Material and methods

We retrospectively analyzed patients who underwent ELCA at Ogaki Municipal Hospital between February 2016 and December 2018. This study was approved by the research review board of Ogaki Municipal Hospital and conducted according to the Helsinki Declaration. Because of its retrospective nature, written informed consent from the participants was waived; however, we excluded the patients who refused to participate in the study.
A pulse-wave xenon chloride excimer laser (Spectranetics CVX-300, Spectranetics, Colorado Springs, Colorado) was applied. It had a 308 nm wavelength, a pulse duration of 135 ns, and an output of 165 mJ/pulse. The laser catheters consisted either of concentric tips (sizes of 0.9, 1.4, 1.7, and 2.0 mm; Vitesse C, Spectranetics) or eccentric tips (sizes 1.7 and 2.0 mm; Vitesse E, Spectranetics). Initial energy parameters for lasing were set at a fluence of 45 mJ/mm2 and 25 Hz and increased if ablation resistance was encountered. The type and size of the laser catheter were chosen...


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