title: Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome.
abstract: BACKGROUND
  Mechanical reperfusion has proven to be an unquestionably superior treatment strategy over that of thrombolytic therapy in patients with acute coronary syndrome (ACS). Excimer laser coronary angioplasty (ELCA) is a unique revascularization device that has a lytic effect on thrombus, in addition to its debulking effect on the atherosclerotic plaque beneath the thrombus.
  
  
  RESULTS
  This single-center retrospective analysis consisted of consecutive ACS patients treated with ELCA (n=50) and age- and sex-matched ACS patients treated with manual aspiration (n=48) without use of a distal protection device. Success rate was judged by lesion crossability, procedure complications, and significant reduction of stenosis. Tissue-level perfusion was assessed on antegrade Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment elevation resolution (STR). Short-term outcome was evaluated according to occurrence of in-hospital major adverse cardiac events (MACE; myocardial infarction, target lesion revascularization, coronary artery bypass graft, and death). Lesion crossability was higher in the ELCA group than in the aspiration group (96.2% vs. 82.6%, P=0.04). Attainment of TIMI 3 flow (86.0% vs. 68.8%, P=0.04) and MBG 3 (76.0% vs. 54.2%, P=0.02) was also higher in the ELCA group than in the aspiration group. Complete STR was similar between the 2 groups. In-hospital MACE were significantly more frequent in the aspiration group.
  
  
  CONCLUSIONS
  ELCA is feasible, safe, and effective for the treatment of patients with ACS and appears to be useful as an adjunctive lesion preparation device.
authors.affiliation: Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shishikura
authors.forename: Satoru
authors.initials: S
authors.lastname: Otsuji
authors.forename: Shin
authors.initials: S
authors.lastname: Takiuchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Fukumoto
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Asano
authors.forename: Masashi
authors.initials: M
authors.lastname: Ikushima
authors.forename: Tokuki
authors.initials: T
authors.lastname: Yasuda
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kashiyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Yabuki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hanafusa
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Higashino
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery*; D000368:Aged; D016342:Angioplasty, Laser; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy