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Lookup NU author(s): Dr Javed Ahmed
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© 2024 HMP Global. All Rights Reserved.Background. Balloon non-crossable stenoses represent a challenging subset of coronary artery disease (CAD). They are clinically associated with patients who are older, frailer, and with multimorbidity, and angiographically with increased tortuosity and coronary artery calcification. Combined rotational (RA) excimer laser coronary atherectomy (ELCA), or RASER, may facilitate stent delivery and deployment in non-crossable, non-dilatable, severely calcified lesions. In this study, we assessed preliminary safety and efficacy of the RASER hybrid technique. Methods. RASER feasible percutaneous coronary intervention (PCI) procedures performed at a large tertiary hospital in the northeast of England were retrospectively analyzed from September 1, 2008 to February 28, 2022. Major endpoints were in-hospital death from any cause, as well as procedural and angiographic success, defined by stent delivery with less than 50% residual stenosis and without clinical or angiographic complications, respectively. Results. From 74 unique cases, there were 28 RASER, 24 ELCA/RA, 16 balloon angioplasty with or without stenting, and 6 medically treated patients. In-hospital mortality rate was 5.2%, including 1 ELCA- and 3 RASER-treated patients. Successful stent delivery was achieved in significantly more RASER-treated patients compared to ELCA/RA- or balloon-treated patients: 96.4% (27/28), 25% (6/24), and 31.3% (5/16), respectively (P < .001). Conclusions. In our retrospective, single center study, patients with CAD who were deemed appropriate for RASER PCI had a high peri-procedural mortality rate. In this context, adjunctive RASER therapy provides acceptable safety and efficacy as a bailout strategy, with at least 3 out of 5 patients achieving satisfactory procedural and angiographic results. Randomized controlled trials are needed to comprehensively compare the clinical outcomes of high-risk RASER PCI vs conservative medical therapy.
Author(s): Hesse K, Mehta S, Tam C, Ahmed F, Shahid F, Mintz GS, Ahmed JM
Publication type: Article
Publication status: Published
Journal: Journal of Invasive Cardiology
Year: 2024
Volume: 36
Issue: 3
Print publication date: 01/03/2024
Online publication date: 20/02/2024
Acceptance date: 02/04/2023
ISSN (print): 1042-3931
ISSN (electronic): 1557-2501
Publisher: Cliggott Publishing Co.
URL: https://doi.org/10.25270/jic/23.00267
DOI: 10.25270/jic/23.00267
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