Browse the corpus

Excimer laser coronary angioplasty (ELCA) is a safe and effective technique as an adjunct to conventional PCI and can improve clinical outcomes when used in the appropriate context. Its primary application currently is for lesions that are uncrossable or un-dilatable with conventional balloons. This article provides a concise review of the ELCA technique and focuses on its role in interventional cardiology. This activity reviews the basic concepts behind excimer lasers, indications and contraindications, procedural steps, potential complications, and highlights the role of the interprofessional team in evaluating and improving care for patients who undergo this procedure. Objectives: Identify the indications for excimer laser coronary angioplasty. Outline the equipment, preparation, and technique in regards to excimer laser coronary angioplasty. Describe the appropriate evaluation and their potential complications and clinical significance of excimer laser coronary angioplasty. Review strategies for improving outcomes from excimer laser coronary angioplasty. Access free multiple choice questions on this topic.

Laser coronary angioplasty was introduced in the early 1980s, mainly to manage balloon-untreatable coronary artery lesions.[1] However, due to the huge cost of the laser system, disappointing results, and complications associated with the continuous waveform of argon and Nd: YAG lasers available at that time, it did not gain popularity.[2][3][4][5] Later in that decade, excimer lasers were developed.  Excimer, an acronym for the excited dimer, produces ultraviolet laser energy pulsatile and short wavelength.  The pulsatile nature ensured the precise ablation of plaque tissue with insignificant thermal injury to the vessel.[6] The short wavelength through less depth of penetration, compared to the infra-red range of argon and Nd: YAG lasers, also limited collateral damage. Both of these properties of excimer lasers, in addition to improvement in catheter design, proper selection of patients, and development of safety protocols, played a crucial role in the reintroduction of laser technology in routine practice.[7][8][9][10] In 1988, the first successful excimer laser coronary angioplasty (ELCA) was performed on a human subject at the Cedar Sinai Medical Center, Los Angeles.[11]

With the optimization of laser catheters and the introduction of safety techniques such as the saline infusion protocol, the incidence of previously seen serious complications such as flow-limiting dissections and vessel perforations has significantly decreased.[8][11][18] Other measures that can prevent these adverse outcomes include avoiding excessive force and lasing on high settings for prolonged periods. Perforations are more likely to occur if an inappropriate size or type of catheter is used (for example, concentric for an eccentrically located lesion), or if energy is applied to a previously dissected segment.[15] If any of these complications occur, the lasing procedure should be aborted, and the complication managed per standard protocol.

Since excimer laser coronary angioplasty (ELCA) is still a relatively new procedure, there are no evidence-based guidelines currently to ensure optimal outcomes. A "5S approach" has been suggested to achieve the best results from ELCA, which are[15]: Selection of patient Size of the laser catheter Settings (fluence and pulse rate) Saline infusion protocol Slow advancement