Combined Rotational excimer lASER coronary atherectomy (RASER) in non-crossable, non-dilatable coronary artery...

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Device Technology

Background:

• Balloon-resistant coronary artery disease (CAD) affects elderly, frail patients with multiple comorbidities.
• These lesions often present with increased tortuosity and calcification, complicating percutaneous coronary intervention (PCI).
• The combined rotational atherectomy (RA) and excimer laser coronary atherectomy (ELCA) technique, termed RASER, aims to improve stent delivery in such cases.

Purpose of the Study:

• To assess the preliminary safety and efficacy of the RASER hybrid technique for treating non-crossable coronary stenoses.
• To evaluate the success rate of stent delivery and deployment in severely calcified lesions using RASER PCI.

Main Methods:

• Retrospective analysis of RASER PCI procedures at a tertiary hospital from 2008 to 2022.
• Evaluation of in-hospital mortality, procedural success (stent delivery <50% residual stenosis), and angiographic success.
• Comparison of RASER outcomes with conventional balloon angioplasty and ELCA/RA alone.

Main Results:

• Successful stent delivery was significantly higher with RASER (96.4%) compared to ELCA/RA (25%) or balloon angioplasty (31.3%) (P < .001).
• The in-hospital mortality rate was 5.2% across all treated patients.
• RASER was utilized in 28 cases, demonstrating its application in complex PCI scenarios.

Conclusions:

• The RASER technique offers acceptable safety and efficacy as a bailout strategy for challenging, non-crossable coronary lesions.
• While peri-procedural mortality was high in this patient cohort, RASER facilitated successful outcomes in a majority of cases.
• Further randomized controlled trials are necessary to compare RASER PCI with conservative medical therapy in high-risk patients.