Safety and efficacy profile of excimer laser coronary angioplasty for thrombus removal in STEMI

ABSTRACT Introduction and objectives: Thrombus removal in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) can be challenging in the presence of a large thrombus burden. Excimer laser coronary angioplasty (ELCA) is an adjuvant device capable of vaporizing thrombus. This study aimed to evaluate the safety and efficacy profile of ELCA in PCI. Methods: Patients with STEMI undergoing PCI with concomitant use of ELCA for thrombus removal were retrospectively identified at our center. Data were collected on the device efficacy and its contribution to overall procedural success. Additionally, ELCA-related complications and major adverse cardiovascular events were recorded at a 2-year follow-up. Results: ELCA was used in 130 STEMI patients, 124 (95.4%) of whom had a large thrombus burden. TIMI grade flow improved significantly after ELCA: before laser application, TIMI grade-0 flow was reported in 79 (60.8%) cases and TIMI grade-1 flow in 32 (24.6%) cases. After ELCA, TIMI grade-2 and 3 flows were achieved in 45 (34.6%) and 66 (50.8%) cases, respectively (P < .001). Technical and procedural success were achieved in 128 (98.5%) and 124 (95.4%) cases, respectively. The complications included 1 death at the cath lab (0.8%), 1 coronary perforation (0.8%), and 3 distal embolizations (2.3%). At the 2-years follow-up, major adverse cardiovascular events occurred in 18.3% of the population. Conclusions: In the context of STEMI, ELCA seems to be an effective device for thrombus dissolution, with adequate technical and procedural success rates. In the present cohort, ELCA use was associated with a low complication rate and favorable long-term outcomes.