Comparison of Excimer Laser Coronary Atherectomy as a Sole Device or as Part of a Multimodality Technique

There are limited data on the use of excimer laser coronary atherectomy (ELCA) in conjunction with other calcium modification devices (intravascular lithotripsy [IVL], rotational/orbital atherectomy [RA/OA]). The aim of this analysis was to compare the use of ELCA as a sole device for coronary intervention with ELCA in combination with additional calcium modification devices. This was a retrospective analysis of all patients treated with ELCA (either as a sole modification device or in conjunction with another calcium modification device) at a single high-volume center. Data and comparisons between ELCA alone and each of the combination therapies (with IVL, with RA/OA, with both IVL and RA/OA) were presented and compared using statistical methods appropriate to the data type. This analysis included 98 interventions using ELCA (67 as a sole device, 22 with IVL, 6 with RA/OA, 3 with IVL and RA/OA). ELCA alone or in conjunction with IVL were most utilized for in stent restenosis/underexpansion compared with ELCA in conjunction with RA/OA +/-IVL, which were used more frequently for uncrossable/calcified lesions. The frequency of coronary artery perforation across the entire cohort was 4.1%. Target vessel revascularization frequency was 9.2%, and target vessel myocardial infarction was 3.1% at a median of 1051 days, with no statistically significant differences between the device groups. ELCA combination therapies have a potential role in certain complex cases and though these are associated with higher risk, they can be safely performed in selected centers using radial access with good medium-term outcomes.