TY - JOUR JO - EuroIntervention TI - The effectiveness of excimer laser angioplasty to treat coronary in-stent restenosis with peri-stent calcium as assessed by optical coherence tomography AB - <p><strong>Aims:</strong> We aimed to evaluate the effectiveness of excimer laser coronary angioplasty (ELCA) to treat in-stent restenosis (ISR) due to peri-stent calcium-related stent underexpansion as assessed by optical coherence tomography (OCT).</p> <p><strong>Methods and results:</strong> We studied 81 patients (81 lesions with ISR, stent underexpansion, and peri-stent calcium &gt;90&deg;) who underwent OCT imaging both pre and post percutaneous coronary intervention and compared lesions treated with ELCA (n=23) vs. without ELCA (n=58). ELCA use was associated with more calcium fracture (ELCA: 61%, non-ELCA: 12%, p&lt;0.01), larger final minimum lumen area (ELCA: 4.76 mm<sup>2</sup> [3.25, 5.57], non-ELCA: 3.46 mm<sup>2</sup> [2.80, 4.13], p&lt;0.01), and a larger previously implanted stent area (ELCA: 6.15 mm<sup>2</sup> [4.83, 7.09], non-ELCA: 4.65 mm<sup>2</sup> [3.84, 5.40], p&lt;0.01). In the multivariable model, ELCA use was associated with peri-stent calcium fracture (odds ratio 46.5, 95% confidence interval: 6.8, 315.9, p&lt;0.001) that, in turn, was associated with final larger lumen and stent dimensions. Finally, contrast injection during ELCA was associated with multiple calcium fractures and fractures even in thicker calcium.</p> <p><strong>Conclusions:</strong> ELCA is effective for treating ISR with underexpansion by disrupting peri-stent calcium, facilitating better expansion of the previously implanted stent.</p> AU - Lee Tetsumin AU - Shlofmitz Richard A. AU - Song Lei AU - Tsiamtsiouris Theofanis AU - Pappas Thomas AU - Madrid Antonio AU - Jeremias Allen AU - Haag S. Elizabeth AU - Ali Ziad A. AU - Moses Jeffrey W. AU - Matsumura Mitsuaki AU - Mintz Gary S. AU - Maehara Akiko VL - 15 IS - 3 Y1 - 12/06/2019 Y1 - 2019 DOI - 10.4244/EIJ-D-18-00139 SP - e279 EP - e288 KW - calcified stenosis KW - in-stent restenosis KW - Laser KW - optical coherence tomography PB - Europa Digital & Publishing SE - Coronary interventions UR - https://eurointervention.pcronline.com/article/the-effectiveness-of-excimer-laser-angioplasty-to-treat-coronary-in-stent-restenosis-with-peri-stent-calcium-as-assessed-by-optical-coherence-tomography SN - 1774-024X ER -