Possible delayed effectiveness of intracoronary laser atherectomy

To the Editor, The excimer laser coronary angioplasty technique was first developed in the early 1980s. However, its safety and effectiveness have only improved in recent years, allowing its integration in an increasing number of cath labs. The technique has a triple mechanism of action: photochemical, photothermal, and photokinetic. When a mixture of hydrogen chloride and a noble gas such as xenon is exposed to a high-voltage electric field, an extremely unstable bond of chlorine and xenon atoms occurs. The separation of these atoms emits a photon which, when amplified, creates a high-energy laser.1 We report the cases of 3 patients, 2 with uncrossable lesions and 1 with rebel stent underexpansion, treated in our unit. Laser atherectomy, along with simultaneous intracoronary infusion of a physiological saline solution (using a 0.9 mm ELCA catheter, Spectranetics, United States), was unsuccessful at the first attempt. This was because, after its application, no other angioplasty devices (predilatation balloons, low-profile microcatheters, or rotational atherectomy guidewires) could be advanced in any of the uncrossable lesions. In the patient with underexpansion, effective dilatation with high-pressure noncompliant balloons after lithotripsy was also unfeasible. These are the only cases treated in our unit with failed laser therapy and a new angioplasty...