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Excimer laser coronary atherectomy (ELCA) has been used for the treatment of complex percutaneous coronary intervention (PCI) such as in-stent restenosis (ISR). However, there was little information about the long-term target lesion revascularization (TLR) after treatment with ELCA. We assessed the long-term TLR after treatment with ELCA for ISR of drug-eluting stents (DES).
A total of 81 consecutive patients with 87 lesions who underwent PCI for ISR of DES between January 2012 and March 2015 were included. According to the use of ELCA, patients were classified into PCI with ELCA group (23 patients with 24 lesions) or PCI without ELCA group (58 patients with 63 lesions). The long-term TLR was evaluated.
The mean duration of clinical follow-up was 29.8 ± 11.6 months. Diffuse restenosis and AHA/ACC type B2 or C lesion in PCI with ELCA group were higher than in PCI without ELCA group. Quantitative coronary angiography of procedural characteristics showed that the baseline minimal luminal diameter of PCI with ELCA group was lower (0.58 ± 0.28 mm vs. 0.88 ± 0.28 mm, p<0.001) and the acute gain after procedure was greater (1.64 ± 0.48 mm vs. 1.26 ± 0.42 mm, p<0.001) than PCI without ELCA group. There was no significant difference in TLR (21.7% vs. 25.9%, p=0.70) between the 2 groups. Figure showed the Kaplan–Meier curves of the estimation of TLR-free survival. Multivariate analysis due to Cox proportional-hazards model showed that multivessel disease was an independent predictor of TLR (HR 3.05, 95% CI 1.22 to 7.61, p=0.017).
ELCA was introduced in severe ISR lesions of DES and effective as an atherectomy device for the lumen enlargement. Despite ELCA use for ISR in the more significantly complex lesions, the long-term TLR was similar and acceptable.
CORONARY: Atherectomy (excluding thrombectomy)