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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:116 - Vol. 70 Num.02 DOI: 10.1016/j.rec.2016.02.025

Effects of Excimer Laser Coronary Atherectomy Assessed by OCT

Daniele Gemma a,, Guillermo Galeote García a, Ángel Sánchez-Recalde a

a Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, Spain

Article

A 61-year-old man presenting with effort angina refractory to treatment underwent coronary angiography demonstrating a severely calcified obstructive lesion in the mid-segment of the left anterior descending artery (Figure 1). Optical coherence tomography (OCT) detected severe circumferential calcification (Figure 1, asterisks), with a calcium nodule protruding into the lumen (Figure 1, arrow, and video 1 of the supplementary material) and a minimal luminal area of 2.4 mm2.

Figure 1.

Due to the severe calcification, excimer laser coronary atherectomy (ELCA) was undertaken. With a 1.4 mm ELCA catheter (Spectranetics, Colorado Springs, Colorado, United States) using an energy of 60 mJ/mm2 at a pulse repetition rate of 40 Hz, we delivered approximately 4000 pulses over 10 runs. The OCT post-ELCA showed calcium fracture and multiple dissection planes, extending deeply into calcified plaque, with irregular intraluminal interface and an increase in minimal luminal area (3.4 mm2) (Figure 1 arrows and video 2 of the supplementary material).

Following predilatation with a 3.5-mm noncompliant balloon, a drug eluting stent (3.5 x 20 mm Xience, Abbot Vascular) was implanted, with good angiographic result (Figure 2). Optical coherence tomography showed good expansion and apposition, with a minimal prolapse of calcified plaque towards vessel lumen (Figure 2, asterisks).

Figure 2.

This case shows the effect of ELCA on coronary calcified plaques assessed by OCT, and its utility in modifying the plaque and facilitating stent expansion.

CONFLICTS OF INTEREST

A. Sánchez-Recalde is Associate Editor of Revista Española de Cardiología.

SUPPLEMENTARY MATERIAL

Supplementary material associated with this article can be found in the online version available at doi:10.1016/j.rec.2016.02.025.

Appendix B. SUPPLEMENTARY MATERIAL

Video 1

Video 2

Corresponding author: daniele.gemma@hotmail.com

1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved