Excimer Laser in Percutaneous Coronary Intervention of Device Uncrossable Chronic Total and Functional Occlusions

Device uncrossable lesions are a challenge in interventional cardiology and despite improvements in balloon and microcatheter profile, rotational atherectomy is necessary in some circumstances in order to ablate and traverse the lesion. Nevertheless, the application of rotational atherectomy requires utilization of a specific wire, Rotawire, which is not always so easily navigable. Debulking of device uncrossable lesions can be performed by coronary laser over any kind of angioplasty guidewire. We present a series of six patients with chronic total (100%) and functional occlusions (99% stenosis) in whom after successful wire crossing, microcatheter failed to traverse the lesion. After coronary laser performance, 5 out of 6 lesions were successfully dilated, achieving a successful final angiographic result of 83.3%.