Laser Atherectomy for Complex CAD in Ischemic Heart Failure: A Systematic Review of Revascularization Outcomes

This review evaluates how laser atherectomy compares to angioplasty and stenting for revascularization in patients with heart failure and complex coronary artery disease (CAD). The review explored whether laser atherectomy could improve procedural success and reduce the risk of restenosis, major cardiovascular events (MACE), and other complications. A search across multiple medical databases yielded six studies directly comparing these treatment methods. Findings showed that procedural success rates were similar between laser atherectomy (ranging from 80% to 95%) and angioplasty/stenting (85% to 98%). Restenosis rates at six and twelve months were also generally equivalent, although laser atherectomy showed potential advantages in treating heavily calcified arteries. The rate of MACE was comparable across both approaches. However, laser atherectomy was associated with a slightly increased risk of complications such as vessel perforation (around 3% vs 1%) and arterial dissection (around 4% vs 2%). Overall, the evidence suggests that laser atherectomy offers outcomes similar to conventional angioplasty and stenting, with particular promise in patients with calcified or complex lesions—especially those with ischemic heart failure. Since severe calcification is common in this patient population, laser atherectomy may be a valuable tool to improve PCI outcomes. However, the conclusions are limited by the small number of studies and the variability in their design and outcomes, highlighting the need for further research with larger sample sizes and standardized outcomes.