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When Do Microbubbles Become Macrobubbles in Laser PCI?

Ilgizar Hart1, Molly Silkowski1, Payton Kendsersky1

  • 1Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA.

JACC. Case Reports
|May 30, 2025
PubMed
Summary
This summary is machine-generated.

Laser atherectomy using contrast can cause macrobubble formation, leading to embolization and hemodynamic issues. Diluting contrast may reduce this risk during coronary interventions.

Keywords:
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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Laser atherectomy is used for treating complex coronary artery disease.
  • Contrast media is essential for visualizing vessels during laser atherectomy.
  • Microbubble formation is a known complication, potentially causing distal embolization.

Observation:

  • A case study involving a 64-year-old female with severe calcified in-stent restenosis and stent underexpansion.
  • Treatment involved excimer laser coronary atherectomy.
  • The procedure was complicated by macrobubble formation, resulting in slow reflow, hypotension, and bradycardia.

Findings:

  • Excimer laser coronary atherectomy with angiographic contrast can lead to macrobubble formation.
  • Macrobubbles can cause distal embolization, slow reflow, and hemodynamic compromise.
  • This complication occurred despite the procedure targeting in-stent restenosis.

Implications:

  • Diluting contrast media may be a strategy to mitigate macrobubble formation during laser atherectomy.
  • Awareness of this complication is crucial for interventional cardiologists.
  • Further research may be needed to optimize contrast use in laser atherectomy procedures.