Trans Radial Excimer Laser Coronary Atherectomy Application During Complex PCI

Lasers were first introduced for the treatment of vascular atherosclerosis in the 1980’s, initially for the treatment of critical limb ischaemia, with subsequent trials that supported its use in the coronary circulation. However, first generation catheters and technique were rudimentary, and were associated with significant complications. Catheter technology development and safer lasing techniques consequently led to significant improvement in clinical outcomes and an increase in uptake amongst interventional cardiologists. Simultaneously this has occurred over a period of change in the vascular access landscape for coronary intervention with adaptation from transfemoral to transradial approach and modification of some techniques to treat complex lesion subsets have evolved. This chapter describes the current indications for the use of Excimer Laser atherectomy in modern interventional practice, which is by default now considered from the transradial approach.A detailed description of the ELCA technique and its potential pitfalls has been illustrated with complex interventional cases performed exclusively from the radial artery. This technology provides a solution to a variety of problems that may be encountered, including massive intra-coronary thrombus, uncrossable lesions including chronic total occlusions and when confronted with stent under expansion. Careful case selection, proper utilization of the laser equipment and incorporation of a safe, efficacious lasing technique play a crucial role in successful laser interventions and ensuring optimal patient outcome.