Contrast‐enhanced excimer laser stepwise approach during PCI for resistant coronary lesions

Background The treatment of resistant coronary lesions (RCL) is a great challenge for interventional cardiologists. The excimer laser coronary atherectomy (ELCA) is a plaque modification tool based on a main mechanism of photomechanical effect leading to mechanical disruption of the plaque. Contrast dye injection during laser delivery has demonstrated to enhance its power. Aim To evaluate the effectiveness and safety of the contrast‐enhanced ELCA by a stepwise approach in the treatment of RCLs. Methods We retrospectively examined consecutive patients undergoing contrast‐enhanced ELCA‐assisted PCI between 2018 and 2021 at two Italian sites. RCLs were defined as novo or in‐stent undilatable/uncrossable with conventional balloons (SC/NC balloon). The primary endpoint was ELCA technical success defined as the laser catheter crossing the entire length of the target lesion established by angiographic evidence of the catheter tip in the artery distal to the stenosis. Results We enrolled 114 patients who underwent contrast‐enhanced ELCA‐assisted PCI: 58% of the patients had acute coronary syndrome while the left anterior descending artery was the target vessel in 42.1% of cases. The target lesion was most commonly in‐stent (56.2%). The 0.9 mm ELCA catheter tip was employed in 89.5% of cases. The most used frequency/fluency profile was 70/70 (39.5%). The use of contrast‐enhanced ELCA was associated with high technical, procedural, and clinical success rates (97.4%, 93.7%, and 90.1%, respectively). Conclusions The contrast‐enhanced ELCA seems to be a safe and effective treatment option for the management of both de novo and in‐stent‐resistant coronary lesions.