Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography

• Published in: Cardiovascular revascularization medicine 2021-01, Vol.22, p.44-49
• Main Authors: Pereira, Gabriel Tensol Rodrigues, Dallan, Luis Augusto P., Vergara-Martel, Armando, Alaiti, Mohamad Amer, Bezerra, Hiram Grando
• Format: Article
• Language: English
• Subjects: Bioresorbable vascular scaffold (BVS); Complex percutaneous coronary intervention (PCI); Excimer laser coronary atherectomy (ELCA); Optical coherence tomography (OCT); Stent restenosis (ISR)
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.05.006

The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single operator, all-comer study, we sought to analyze the performance of ELCA followed by bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) for ISR. A total of 13 patients had ISR treated with a combination of ELCA and BVS, with 9 patients having matched OCT pre, post ELCA and post BVS. Mean age was 65 ± 11.22 and 83% of the patients were male. Hypertension and dyslipidemia were present in 100% of the patients and smoking and diabetes in 50%. After the procedure, we did not detect residual stenosis over 10% in any patient, resulting in a technical success of 100%. No patients had MACE during their hospital stay or within the next six months, resulting in a procedure success of 100%. The mean lumen area increased 0.35 mm2 from pre procedure to post ELCA and 3.58 mm2 from post ELCA to post BVS. The final difference, from pre procedure to post BVS, was a 3.93 mm2 lumen area gain. The mean lumen diameter increased 0.11 mm from baseline to ELCA, 0.95 mm from post laser to BVS implantation and 1.06 mm from pre procedure to post BVS. The NIH area reduced 0.48 mm2 from pre to post ELCA, 1.13mm2 from post ELCA to BVS implantation and 1.61 mm2 from baseline to post BVS implantation. We conclude that ELCA is a safe and feasible debulking method to approach ISR, with high rates of post-procedural BVS success, within six months follow-up. •Excimer laser coronary atherectomy (ELCA) is an adjuvant procedure to percutaneous coronary intervention (PCI) and plays an important role in the management of in-stent restenosis (ISR).•Optical coherent tomography (OCT) is especially important in cases of ISR to determine the mechanism of restenosis, the anatomy of the lesion, and its approach.•Bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) might have an important roll in the ISR scenario.•Excimer laser coronary atherectomy (ELCA) is a safe and feasible debulking method to approach ISR, with high rates of post-procedural BVS success.