CONGRESS ABSTRACT

Rationale : The high calcific coronary lesions are one of the hardest challenges for interventional cardiologists, with an adverse impact on both acute and long-term results of percutaneous coronary intervention (PCI). Nowadays, several technologies have been developed to facilitate the plaque modification, particularly in situations where a lesion is balloon-unexpandable or uncrossable. Among these, the Excimer Laser Coronary Atherectomy (ECLA) is a well-established, safe and effective method of plaque modification. The excimer laser is a pulsed xenon-chlorine laser with an ultraviolet wavelength of 308 nm, which relies on absorption into non-aqueous components of the atherosclerotic plaque for the debulking. Tissue ablation is mediated by three mechanisms: photochemical, photothermal and photomechanical. The use of laser at the highest fluence and repetition rate (i.e., 80 mJ/mm2 and 80 Hz) during contrast injection maximizes the photothermal and the photomechanical effect and is called “explosion technique”. Technical resolution : In our case, there was a critical and severe calcific lesion in the middle left anterior descending (LAD) artery. This lesion could not be crossed even with small-diameter balloons (SC balloon 1.5 x 8 mm). In our catheterization laboratory, we have an extensive experience with ECLA use. Thus, we decided to use the laser to perform a plaque modification. After the use of TurboElite 0.9 mm catheter (with the “explosion technique” – fluence/repetition rate 80/80 – 2755 pulses in 30”), we successfully crossed the lesion with NC balloons of increasing diameter. Subsequently, with the support of a guide catheter extension, we implanted three drug eluting stents in overlap from the middle LAD to the ostium of left main (LM). To conclude, we performed a run of IVUS that showed a good stent expansion in LAD and LM without signs of distal dissection. Clinical implications and perspectives : The ECLA is a plaque modification technique truly useful when the lesion is balloon- or wire-uncrossable. When used by expert operators, it is safe and allows a high rate of procedural success. Unlike other atherectomy methods (i.e. rotational/orbital atherectomy), it does not require a dedicated wire, and the risk of distal embolization is significant lower if compared with them. The main limitations of this technique are costs, time preparation to start the system and the large size of generator, limitations that will surely be smoothed in the future.