Laser therapy

Summary

Excimer laser coronary angioplasty (ELCA) was introduced more than two decades ago as an alternative to balloon angioplasty (PTCA) for the treatment of obstructed coronary arteries. This technology is designed to ablate the obstructive atherothrombotic plaque rather than creating plastic deformation to increase vessel lumen dimensions as in PTCA. In addition, beneficial effects on platelet aggregation and thrombus dissolution have been reported. However, despite technical and procedural improvements over time, ELCA has failed to show better angiographic, procedural, or clinical outcome results when compared to PTCA. Moreover, since coronary stents emerged at the same time (as an alternative to PTCA) with superior procedure-related safety results and lower rates of restenosis or reintervention, the coronary ELCA application is now limited to some niche indications. These include: the undilatable lesion, chronic total occlusions with successful wire passage but inability to advance a balloon, long and diffuse atherosclerotic lesions or in-stent restenosis (due to excessive neointimal proliferation), ostial or bifurcation lesions requiring ablative plaque modification, and in primary PCI with large thrombus burden as an adjunct or alternative to conventional thrombectomy devices. Therefore in the current era of drug-eluting stents, the aim of laser therapy is to facilitate an optimal final stent implantation...