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Vol. 70. Issue 2.
Pages 116 (February 2017)
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Vol. 70. Issue 2.
Pages 116 (February 2017)
Image in cardiology
DOI: 10.1016/j.rec.2016.02.025
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Effects of Excimer Laser Coronary Atherectomy Assessed by OCT
Efectos de la aterectomía con láser valorados con OCT
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Daniele Gemma
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daniele.gemma@hotmail.com

Corresponding author:
, Guillermo Galeote García, Ángel Sánchez-Recalde
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, Spain
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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 1A). Optical coherence tomography (OCT) detected severe circumferential calcification (Figure 1A, asterisks), with a calcium nodule protruding into the lumen (Figure 1A, arrow, and video 1 of the supplementary material) and a minimal luminal area of 2.4mm2.

Figure 1
(0.11MB).

Due to the severe calcification, excimer laser coronary atherectomy (ELCA) was undertaken. With a 1.4mm ELCA catheter (Spectranetics, Colorado Springs, Colorado, United States) using an energy of 60mJ/mm2 at a pulse repetition rate of 40Hz, 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 (3.4mm2) (Figure 1B arrows and video 2 of the supplementary material).

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

Figure 2
(0.12MB).

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.

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

Copyright © 2016. Sociedad Española de Cardiología
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