The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography.
EuroIntervention
; 15(3): e279-e288, 2019 Jun 12.
Article
en En
| MEDLINE
| ID: mdl-29769164
ABSTRACT
AIMS:
We aimed to evaluate the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent underexpansion as assessed by optical coherence tomography (OCT). METHODS ANDRESULTS:
We studied 81 patients (81 lesions with ISR, stent underexpansion, and peri-stent calcium >90°) who underwent OCT imaging both pre and post percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs. without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA 61%, non-ELCA 12%, p<0.01), larger final minimum lumen area (ELCA 4.76 mm2 [3.25, 5.57], non-ELCA 3.46 mm2 [2.80, 4.13], p<0.01), and a larger previously implanted stent area (ELCA 6.15 mm2 [4.83, 7.09], non-ELCA 4.65 mm2 [3.84, 5.40], p<0.01). In the multivariable model, ELCA use was associated with peri-stent calcium fracture (odds ratio 46.5, 95% confidence interval 6.8, 315.9, p<0.001) that, in turn, was associated with final larger lumen and stent dimensions. Finally, contrast injection during ELCA was associated with multiple calcium fractures and fractures even in thicker calcium.CONCLUSIONS:
ELCA is effective for treating ISR with underexpansion by disrupting peri-stent calcium, facilitating better expansion of the previously implanted stent.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Stents
/
Angioplastia por Láser
/
Reestenosis Coronaria
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
EuroIntervention
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
TERAPEUTICA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos