Abstract 16634: Use of Excimer Laser Coronary Atherectomy for the Revascularisation of Coronary Artery Chronic Total Occlusions After Failure to Cross With Balloon
Background: Revascularisation of chronic total occlusions (CTO) has a success rate of 60 to 80% compared to 90% for other lesions. Although rotablation and other technologies have improved these revascularisation success rates, CTOs still remain challenging. Excimer laser coronary atherectomy (ELCA) has been successfully used for coronary intervention for more than 20 years. Our centre is the highest volume centre for ECLA in the UK. We present the results of the largest prospective cohort study examining the use of ECLA in CTOs where balloons have failed to cross the lesion.
Methods: We prospectively enrolled patients undergoing revascularisation of CTOs at Kettering General Hospital, UK in whom the CTO was successfully wired but balloon dilatation or microcatheter passage failed because of an inability to enter the lesion. Patients were followed up and 30 day MACE rates were calculated.
Results: From February 2011 until September 2012 a total of 27 patients had ELCA adjunctive therapy used in revascularisation of a CTO when inability to enter the lesion was encountered after wire passage. All 27 procedures were successful, with 85% of the cohort being male with a mean age of 69±11 years. Chronic kidney disease was present in 7% and only 33% had LV systolic dysfunction (LVEF<50%). All but one patient underwent the procedure electively, with this patient having ELCA supported revascularisation of a CTO in context of an acute non-ST elevation myocardial infarction. Table 1 describes the procedural and ECLA details. There were no immediate in hospital complications or MACE. There was 1 MACE event during 30 day follow up documented (1 transient cerebral ischaemic event).
Conclusion: Our data, the largest of its kind, shows that ECLA supported CTO revascularisation is a safe and successful technique when lesions are un-crossable by balloons or other devices. It may therefore help improve revascularisation rates in this important patient sub-group
- © 2013 by American Heart Association, Inc.