title: Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions.
abstract: OBJECTIVE
  To establish success and complication rates of excimer laser coronary atherectomy (ELCA) in a contemporary series of patients with balloon failure during percutaneous coronary intervention (PCI) of both chronic total occlusions (CTO) and lesions with distal TIMI 3 flow.
  
  
  RESULTS
  We identified 58 cases of balloon failure treated with ELCA±rotational atherectomy (RA) over four years, representing 0.84% of all PCI performed in our centre during this period. Balloon failures were classified according to: (i) mechanism of balloon failure; and (ii) whether this occurred in the context of treating a CTO. ELCA was performed following balloon failure using the CVX-300 Excimer Laser System and a 0.9 mm catheter with saline flush. For the entire cohort, procedure success was achieved in 91% (with ELCA successful: alone in 76.1%, after RA failure in 6.8% and in combination with RA for 8.6%). Only in one case did RA succeed where ELCA had failed. There were four procedure-related complications, including transient no-reflow, side branch occlusion and two coronary perforations, of which one was directly attributable to ELCA and led to subsequent mortality.
  
  
  CONCLUSIONS
  ELCA provides safe and effective adjunctive therapy in contemporary PCI to treat lesions associated with balloon failure due to an inability either to cross the lesion or to expand a balloon sufficiently to permit stenting. ELCA was successful in the majority of these selected cases when used independently with further effectiveness achieved when combined with RA or after RA failure.
authors: Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
authors: Juan P
authors: JP
authors: Fernandez
authors: Alex R
authors: AR
authors: Hobson
authors: Daniel
authors: D
authors: McKenzie
authors: Nimit
authors: N
authors: Shah
authors: Manas K
authors: MK
authors: Sinha
authors: Tim A
authors: TA
authors: Wells
authors: Terry M
authors: TM
authors: Levy
authors: Rosie A
authors: RA
authors: Swallow
authors: Suneel
authors: S
authors: Talwar
authors: Peter D
authors: PD
authors: O'Kane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D062906:Cardiac Catheters; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D054059:Coronary Occlusion / Q000175:diagnosis / Q000628:therapy*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D012189:Retrospective Studies; D016896:Treatment Outcome