Laser for balloon uncrossable and undilatable chronic total occlusion interventions

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Limited data exists on laser utilization in complex percutaneous coronary interventions (PCI).
• Balloon uncrossable and undilatable lesions pose significant challenges in chronic total occlusion (CTO) PCI.

Purpose of the Study:

• To evaluate the impact of laser use on outcomes in balloon uncrossable and undilatable CTO PCI.
• To assess technical success, procedural success, and major adverse cardiac events (MACE) associated with laser use in challenging CTO lesions.

Main Methods:

• Retrospective analysis of 4845 CTO PCI cases from 32 centers (2012-2020).
• Included 752 lesions that were either balloon uncrossable or undilatable.
• Compared outcomes between cases with and without laser use.

Main Results:

• Laser was used in 20.3% of challenging CTO lesions, particularly longer occlusions and in-stent restenosis.
• Laser use was linked to higher technical success (91.5% vs. 83.1%) and procedural success (88.9% vs. 81.6%).
• No significant difference in major adverse cardiac events (3.92% vs. 3.51%) was observed, though procedural and fluoroscopy times were longer with laser.

Conclusions:

• Balloon uncrossable/undilatable lesions constitute 15.5% of CTO PCI cases.
• Laser utilization in these complex cases is associated with high technical and procedural success rates.
• Laser use in CTO PCI demonstrates comparable safety profiles regarding major complications.