The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography
Lee, T., Shlofmitz, R.A., Song, L., Tsiamtsiouris, T., Pappas, T., Madrid, A., Jeremias, A., Haag, E.S., Ali, Z.A., Moses, J.W., Matsumura, M., Mintz, G.S., & Maehara, A. (2019).
By Anne Li, Research Assistant
The ELCA study, published in EuroIntervention, demonstrates the efficacy and mechanism of excimer laser coronary angioplasty (ELCA) in treating coronary in-stent restenosis (ISR) due to underexpansion caused by peri-stent calcium. The study evaluated patients from St. Francis Hospital and NewYork-Presbyterian Hospital, with substantial contributions made by St. Francis Hospital investigators under the direction of Dr. Richard Shlofmitz. ELCA is a technique used to modify calcium burden to prevent stent underexpansion, which is one of the most frequent causes of stent failure, but it has been underused, and its effectiveness and mechanism are not well known. The study demonstrated that ELCA is effective for treating in-stent restenosis, with intra-coronary imaging by optical coherence tomography elucidating the mechanism by which ELCA disrupts peri-stent calcium, thereby promoting better expansion of the implanted stent resulting in larger vessel lumen and stent area, and lesions treated with ELCA had greater fracture of peri-stent calcium. Overall, the study has far-ranging clinical implications: ELCA can effectively treat coronary in-stent restenosis due to peri-stent calcium, leading to improved interventional outcomes.