Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
EuroIntervention. 2013 Jun 22;9(2):243-50. doi: 10.4244/EIJV9I2A40.
To establish success and complication rates of excimer laser coronary atherectomy (ELCA) in a contemporary series of patients with balloon failure during percutaneous coronary intervention (PCI) of both chronic total occlusions (CTO) and lesions with distal TIMI 3 flow.
We identified 58 cases of balloon failure treated with ELCA±rotational atherectomy (RA) over four years, representing 0.84% of all PCI performed in our centre during this period. Balloon failures were classified according to: (i) mechanism of balloon failure; and (ii) whether this occurred in the context of treating a CTO. ELCA was performed following balloon failure using the CVX-300 Excimer Laser System and a 0.9 mm catheter with saline flush. For the entire cohort, procedure success was achieved in 91% (with ELCA successful: alone in 76.1%, after RA failure in 6.8% and in combination with RA for 8.6%). Only in one case did RA succeed where ELCA had failed. There were four procedure-related complications, including transient no-reflow, side branch occlusion and two coronary perforations, of which one was directly attributable to ELCA and led to subsequent mortality.
ELCA provides safe and effective adjunctive therapy in contemporary PCI to treat lesions associated with balloon failure due to an inability either to cross the lesion or to expand a balloon sufficiently to permit stenting. ELCA was successful in the majority of these selected cases when used independently with further effectiveness achieved when combined with RA or after RA failure.
在经皮冠状动脉介入治疗（PCI）中，当球囊在慢性完全闭塞（CTO）病变或远段 TIMI 3 级血流病变中无法通过或充分扩张时，采用准分子激光冠状动脉斑块切除术（ELCA），建立该技术的成功率和并发症发生率。
我们在四年间识别出 58 例球囊失败患者，采用 ELCA±旋磨术（RA）治疗，占同期中心所有 PCI 的 0.84%。根据：（i）球囊失败的机制；和（ii）是否在治疗 CTO 的背景下发生，对球囊失败进行分类。ELCA 在球囊失败后使用 CVX-300 准分子激光系统和带有盐水冲洗的 0.9 毫米导管进行。对于整个队列，91%的患者达到了手术成功（单独使用 ELCA 成功：76.1%，RA 失败后成功：6.8%，与 RA 联合使用成功：8.6%）。只有在 1 例 RA 失败的情况下，ELCA 成功了。有 4 例与操作相关的并发症，包括短暂无复流、侧支闭塞和 2 例冠状动脉穿孔，其中 1 例直接归因于 ELCA，并导致随后的死亡。
ELCA 在当代 PCI 中为治疗因无法通过病变或充分扩张球囊以允许支架置入而导致的球囊失败相关病变提供了安全有效的辅助治疗。在这些选定的病例中，ELCA 独立应用的成功率较高，与 RA 联合应用或在 RA 失败后应用时效果进一步提高。
