Abstract 14639: Long-term Clinical Outcomes After Treatment With Excimer Laser Coronary Atherectomy for In-Stent Restenosis of Drug-Eluting Stent
Introduction: Excimer laser coronary atherectomy (ELCA) has been used for the treatment of complex percutaneous coronary intervention (PCI) such as in-stent restenosis (ISR). However, there was little information about the long-term outcomes after treatment with ELCA.
Hypothesis: We assessed the long-term clinical outcomes after treatment with ELCA for ISR of DES.
Methods: A total of 81 consecutive patients with 87 lesions who underwent PCI for ISR of DES between January 2012 and March 2015 were included. According to the use of ELCA, patients were classified into PCI with ELCA group (23 patients with 24 lesions) or PCI without ELCA group (58 patients with 63 lesions). The major adverse cardiac events (MACE) including all-cause death, myocardial infarction and target lesion revascularization (TLR) were evaluated.
Results: The mean duration of clinical follow-up was 29.8 ± 11.6 months. Diffuse restenosis and AHA/ACC type B2 or C lesion in PCI with ELCA group were higher than in PCI without ELCA group. Quantitative coronary angiography of procedural characteristics showed that the baseline minimal luminal diameter of PCI with ELCA group was lower (0.58 ± 0.28 mm vs. 0.88 ± 0.28 mm, p<0.001) and the acute gain after procedure was greater (1.64 ± 0.48 mm vs. 1.26 ± 0.42 mm, p<0.001) than PCI without ELCA group. There was no significant difference in all-cause death (0.0% vs. 0.0%, p=NA), myocardial infarction (4.3% vs. 3.4%, p=0.85) and TLR (21.7% vs. 25.9%, p=0.70) between the 2 groups. Figure showed the Kaplan-Meier curves of the estimation of MACE-free survival. Multivariate analysis due to Cox proportional-hazards model showed that multivessel disease was an independent predictor of MACE (HR 3.05, 95% CI 1.22 to 7.61, p=0.017).
Conclusions: ELCA was introduced in severe ISR lesions of DES and effective as an atherectomy device for the lumen enlargement. Despite ELCA use for ISR in the more significantly complex lesions, the long-term outcomes were favorable and similar.
Author Disclosures: E. Ichimoto: None. T. Kadohira: None. J. De Gregorio: None.
- © 2016 by American Heart Association, Inc.