Skip to main content

Advertisement

SpringerLink
Log in

Benefits of excimer laser coronary angioplasty over thrombus aspiration therapy for patients with acute coronary syndrome and thrombolysis in myocardial infarction flow grade 0

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

In primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), the presence of a thrombus or unstable plaque can cause microvascular obstructions, which may increase infarct size and reduce survival. Excimer laser coronary angioplasty (ELCA) is a unique revascularization technique that can vaporize plaques and thrombi. However, to date, only few reports indicate the efficacy of ELCA for ACS. We retrospectively analyzed 113 consecutive ACS patients who underwent PCI with either ELCA or manual thrombus aspiration therapy (TA) before balloon angioplasty or stenting and who had a Thrombolysis in Myocardial Infarction flow (TIMI) grade 0 on the first contrast injection within 24 h of onset at our hospital from March 2011 to March 2020. Patients were divided into two groups by the procedure used: ELCA (N = 48) and TA (N = 50). Door-to-reperfusion time was significantly shorter in the ELCA group than TA group (89.2 ± 6.7 vs. 137.9 ± 12.3 min, respectively; P < 0.01). There was also a significant difference in peak creatine kinase-myocardial band between the ELCA and TA groups (242 ± 25 vs. 384 ± 63 IU/L, respectively; P = 0.04). Although there was no difference in myocardial blush grade (MBG) before treatment, the MBG after treatment was higher in the ELCA group (P < 0.01). In-hospital major adverse cardiac events (MACE) were also significantly fewer in the ELCA group than in the TA group (8% vs. 20%, P = 0.045). ELCA for TIMI grade 0 ACS may shorten reperfusion time, improve the MBG score, and reduce MACE when compared to TA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request.

References

  1. Anderson JL, Morrow DA (2017) Acute myocardial infarction. N Engl J Med 376:2053–2064. https://doi.org/10.1056/NEJMra1606915

    Article  CAS  PubMed  Google Scholar 

  2. De Luca G, Dudek D, Sardella G, Marino P, Chevalier B, Zijlstra F (2008) Adjunctive manual thrombectomy improves myocardial perfusion and mortality in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis of randomized trials. Eur Heart J 29:3002–3010. https://doi.org/10.1093/eurheartj/ehn389

    Article  PubMed  Google Scholar 

  3. Stone GW, Webb J, Cox DA, Brodie BR, Qureshi M, Kalynych A, Turco M, Schultheiss HP, Dulas D, Rutherford BD, Antoniucci D, Krucoff MW, Gibbons RJ, Jones D, Lansky AJ, Mehran R, Efficacy EM, Recovery by Aspiration of Liberated Debris (EMERALD) Investigators, (2005) Distal microcirculatory protection during percutaneous coronary intervention in acute ST-segment elevation myocardial infarction: a randomized controlled trial. JAMA 293:1063–1072. https://doi.org/10.1001/jama.293.9.1063

    Article  CAS  PubMed  Google Scholar 

  4. Topaz O, Shah R, Mohanty PK, McQueen RA, Janin Y, Bernardo NL (2001) Application of excimer laser angioplasty in acute myocardial infarction. Lasers Surg Med 29:185–192. https://doi.org/10.1002/lsm.1108

    Article  CAS  PubMed  Google Scholar 

  5. Ilkay E, Karaca I, Yavuzkir M, Akbulut M, Pekdemir M (2005) The effect of interventional treatment in acute myocardial infarction on ST resolution: a comparison of coronary angioplasty with excimer laser angioplasty. Angiology 56:377–384. https://doi.org/10.1177/000331970505600403

    Article  PubMed  Google Scholar 

  6. Dörr M, Vogelgesang D, Hummel A, Staudt A, Robinson DM, Felix SB, Dahm JB (2007) Excimer laser thrombus elimination for prevention of distal embolization and no-reflow in patients with acute ST elevation myocardial infarction: results from the randomized LaserAMI study. Int J Cardiol 116:20–26. https://doi.org/10.1016/j.ijcard.2006.03.024

    Article  PubMed  Google Scholar 

  7. Ambrosini V, Cioppa A, Salemme L, Tesorio T, Sorropago G, Popusoi G, Stabile E, Medolla A, Cangella F, Agrusta M, Picano E, Rubino P (2008) Excimer laser in acute myocardial infarction: single centre experience on 66 patients. Int J Cardiol 127:98–102. https://doi.org/10.1016/j.ijcard.2007.10.060

    Article  CAS  PubMed  Google Scholar 

  8. Masuda R, Shibui T, Mizunuma Y, Yoshikawa S, Takeda K, Kujiraoka H, Yamaoka K, Arai T, Inagaki D, Kimura T, Yoshida K, Takahashi M, Kitamura T, Hojo R, Tsuchiyama T, Fukamizu S, Sasano T (2022) Impact of small diameter and low level of emission laser coronary atherectomy in patients with acute myocardial infarction. Lasers Med Sci 37:1567–1573. https://doi.org/10.1007/s10103-021-03405-y

    Article  PubMed  Google Scholar 

  9. Topaz O, Lippincott R, Bellendir J, Taylor K, Reiser C (2001) “Optimally spaced” excimer laser coronary catheters: performance analysis. J Clin Laser Med Surg 19:9–14. https://doi.org/10.1089/104454701750066884

    Article  CAS  PubMed  Google Scholar 

  10. TIMI Study Group (1985) The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 312:932–936. https://doi.org/10.1056/NEJM198504043121437

    Article  Google Scholar 

  11. van’t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F (1998) Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade Zwolle Myocardial Infarction Study Group. Circulation 97:2302–2306. https://doi.org/10.1161/01.cir.97.23.2302

    Article  PubMed  Google Scholar 

  12. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888. https://doi.org/10.1161/01.cir.93.5.879

    Article  CAS  PubMed  Google Scholar 

  13. Huber MS, Mooney JF, Madison J, Mooney MR (1991) Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol 68:467–471. https://doi.org/10.1016/0002-9149(91)90780-o

    Article  CAS  PubMed  Google Scholar 

  14. Kloner RA, Ganote CE, Jennings RB (1974) The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest 54:1496–1508. https://doi.org/10.1172/JCI107898

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Uchida Y, Ichimiya S, Ishii H, Kanashiro M, Watanabe J, Yoshikawa D, Takeshita K, Sakai S, Amano T, Matsubara T, Murohara T (2012) Impact of metabolic syndrome on various aspects of microcirculation and major adverse cardiac events in patients with ST-segment elevation myocardial infarction. Circ J 76:1972–1979. https://doi.org/10.1253/circj.cj-11-1299

    Article  PubMed  Google Scholar 

  16. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F (2008) Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 371:1915–1920. https://doi.org/10.1016/S0140-6736(08)60833-8

    Article  PubMed  Google Scholar 

  17. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, Kedev S, Thabane L, Stankovic G, Moreno R, Gershlick A, Chowdhary S, Lavi S, Niemelä K, Steg PG, Bernat I, Xu Y, Cantor WJ, Overgaard CB, Naber CK, Cheema AN, Welsh RC, Bertrand OF, Avezum A, Bhindi R, Pancholy S, Rao SV, Natarajan MK, ten Berg JM, Shestakovska O, Gao P, Widimsky P, Džavík V, Investigators TOTAL (2015) Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 372:1389–1398. https://doi.org/10.1056/NEJMoa1415098

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Topaz O (1996) Plaque removal and thrombus dissolution with the photoacoustic energy of pulsed-wave lasers-biotissue interactions and their clinical manifestations. Cardiology 87:384–391. https://doi.org/10.1159/000177125

    Article  CAS  PubMed  Google Scholar 

  19. Topaz O, Minisi AJ, Bernardo NL, McPherson RA, Martin E, Carr SL, Carr ME Jr (2001) Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet” phenomenon. Thromb Haemost 86:1087–1093

    Article  CAS  PubMed  Google Scholar 

  20. Shishikura D, Otsuji S, Takiuchi S, Fukumoto A, Asano K, Ikushima M, Yasuda T, Hasegawa K, Kashiyama T, Yabuki M, Hanafusa T, Higashino Y (2013) Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome. Circ J 77:1445–1452. https://doi.org/10.1253/circj.cj-12-1064

    Article  PubMed  Google Scholar 

  21. Nagamine S, Ashikaga T, Masuda S, Komiyama K, Tsuchiyama T, Shibui T, Hirao K (2019) Comparison of 0.9-mm and 1.4-mm catheters in excimer laser coronary angioplasty for acute myocardial infarction. Lasers Med Sci 34:1747–1754. https://doi.org/10.1007/s10103-019-02772-x

    Article  PubMed  Google Scholar 

  22. Sintek M, Coverstone E, Bach R, Zajarias A, Lasala J, Kurz H, Kennedy K, Singh J (2021) Excimer laser coronary angioplasty in coronary lesions: use and safety from the NCDR/CATH PCI Registry. Circ Cardiovasc Interv 14:e010061. https://doi.org/10.1161/CIRCINTERVENTIONS.120.010061

    Article  CAS  PubMed  Google Scholar 

  23. Tsutsui RS, Sammour Y, Kalra A, Reed G, Krishnaswamy A, Ellis S, Nair R, Khatri J, Kapadia S, Puri R (2021) Excimer laser atherectomy in percutaneous coronary intervention: a contemporary review. Cardiovasc Revasc Med 25:75–85. https://doi.org/10.1016/j.carrev.2020.10.016

    Article  PubMed  Google Scholar 

  24. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20. https://doi.org/10.1016/S0140-6736(03)12113-7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan

    Tomoyuki Arai, Takaaki Tsuchiyama, Dai Inagaki, Kiyotaka Yoshida & Seiji Fukamizu

Authors
  1. Tomoyuki Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takaaki Tsuchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dai Inagaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kiyotaka Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seiji Fukamizu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by TA, TT, DI, and SF. The first draft of the manuscript was written by TA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tomoyuki Arai.

Ethics declarations

Ethical approval

The study was approved by the ethics committee of the Tokyo Metropolitan Hiroo Hospital, Japan.

Informed consent

All patients provided written informed consent to receive ELCA or TA treatment and permission to use their data.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arai, T., Tsuchiyama, T., Inagaki, D. et al. Benefits of excimer laser coronary angioplasty over thrombus aspiration therapy for patients with acute coronary syndrome and thrombolysis in myocardial infarction flow grade 0. Lasers Med Sci 38, 13 (2023). https://doi.org/10.1007/s10103-022-03691-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10103-022-03691-0

Keywords

Search

Navigation