The effectiveness of excimer laser coronary atherectomy with contrast medium for underexpanded stent: The findings of optical frequency domain imaging
- 7 March 2015
- journal article
- case report
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 86 (5), 946-949
- https://doi.org/10.1002/ccd.25915
Abstract
Stent underexpansion is a risk factor for in‐stent restenosis (ISR) and stent thrombosis. Although excimer laser coronary atherectomy (ELCA) with contrast medium was shown to be effective to improve stent underexpansion in undilatable lesions, precise mechanism of this technique was not well understood. We report a case of ISR with stent underoptimal implantation within a circumferential‐calcified atherosclerotic plaque beneath the stent strut that could not be dilated by repeated high‐pressure balloon inflations. After rotational atherectomy, the mechanism of the underexpanded lesion could be obtained by optical frequency domain imaging (OFDI). High‐pressure balloon could not dilate the underexpanded stent. Since ELCA with saline flush only gave intimal erosions and minor dissections, additional high‐pressure balloon was also ineffective. Finally, ELCA with contrast medium could disrupt the calcific lesion beneath the underexpanded stent. The angiographic and OFDI findings confirmed the full stent expansion could be accomplished by further balloon dilatation with an ordinary pressure. ELCA with contrast medium is feasible to improve stent underexpansion by disrupting the calcified plaque behind the stent strut.Keywords
This publication has 9 references indexed in Scilit:
- Excimer Laser LEsion Modification to Expand Non-dilatable sTents: The ELLEMENT RegistryCardiovascular Revascularization Medicine, 2013
- Excimer laser in management of underexpansion of a newly deployed coronary stentCatheterization and Cardiovascular Interventions, 2013
- Laser “explosion” technique for treatment of unexpanded coronary stentInternational Journal of Cardiology, 2011
- High energy excimer laser to treat coronary in‐stent restenosis in an underexpanded stentCatheterization and Cardiovascular Interventions, 2008
- Managing a complication after direct stenting: removal of a maldeployed stent with rotational atherectomyHeart, 2005
- Plaque Removal and Thrombus Dissolution with the Photoacoustic Energy of Pulsed-Wave Lasers – Biotissue Interactions and Their Clinical ManifestationsJMIR AI, 1996
- Effect of intracoronary saline infusion on dissection during excimer laser coronary angioplasty: A randomized trialJournal of the American College of Cardiology, 1995
- Development of a new technique for reducing pressure pulse generation during 308‐nm excimer laser coronary angioplastyCatheterization and Cardiovascular Diagnosis, 1995
- Intraluminal vapor bubble induced by excimer laser pulse causes microsecond arterial dilation and invagination leading to extensive wall damage in the rabbit.Circulation, 1993