title: Excimer Laser LEsion modification to expand non-dilatable stents: the ELLEMENT registry.
abstract: OBJECTIVE
  Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective.
  
  
  RESULTS
  ECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent. The primary endpoint of successful laser dilatation was defined as an increase of at least 1mm(2) in minimal stent cross-sectional area (MSA) on IVUS or an increase of at least 20% in minimal stent diameter (MSD) by QCA, following redilatation with the same non-compliant balloon that had been unsuccessful prior to ELCA. Secondary endpoints were cardiac death, myocardial infarction (MI) and target lesion revascularization. Between June 2009 and November 2011, 28 patients with an underexpanded stent despite high-pressure balloon inflation were included. The mean laser catheter size was 1.2±0.4 (range 0.9-2.0mm) and a mean of 62±12mJ/mm(2) at 62±21hertz were required for optimal expansion. Laser-assisted stent dilatation was successful in 27 cases (96.4%), with an improvement in MSD by QCA (1.6±0.6mm at baseline to 2.6±0.6mm post-procedure) and MSA by IVUS (3.5±1.1mm(2) to 7.1±1.9mm(2)). Periprocedural MI occurred in 7.1%, transient slow-flow in 3.6% and ST elevation in 3.6%. During follow-up, there were no MIs, there was 1 cardiac-death, and TLR occurred in 6.7%.
  
  
  CONCLUSIONS
  The ELLEMENT study confirms the feasibility of ELCA with contrast injection to improve stent underexpansion in undilatable stented lesions.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Interventional Cardiology Unit, Spedali Civili, Brescia, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Chizzola
authors.affiliation: Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tobis
authors.affiliation: Invasive Cardiology Division, Clinica Montevergine, Mercogliano, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Ambrosini
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: Dept.of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Sardella
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, Catania, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: DiSalvo
authors.affiliation: Department of Clinical Research, Delta Hospital, Prato, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Armigliato
authors.affiliation: Cardiovascular Institute, Azienda Opedaliera Universitaria di Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.affiliation: Heart Department, San Carlo Hospital, Potenza, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Tarsia
authors.affiliation: Interventional Cardiology Unit, Azienda Ospedali Riuniti, Ancona.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gabrielli
authors.affiliation: Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lazar
authors.affiliation: Interventional Cardiology Unit, Spedali Civili, Brescia, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Maffeo
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy. Electronic address: info@emocolumbus.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017222:Angioplasty, Balloon, Laser-Assisted / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003287:Contrast Media; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010865:Pilot Projects; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D003287:Contrast Media
keywords: Excimer Laser Coronary Angioplasty; In-stent restenosis