Excimer Laser Coronary Angioplasty in Coronary Lesions: Use and Safety from the NCDR/CATH PCI Registry

Background: Excimer laser coronary angioplasty (ELCA) uses an ultraviolet laser catheter for the treatment of coronary artery disease. ELCA has been used for various coronary lesions, but current safety and frequency of use are unknown. Methods: We performed a retrospective, registry-based study of ELCA use during coronary interventions reported to the National Cardiovascular Data Registry/CATH percutaneous coronary intervention registry from 2009 to 2018 (n=6 043 596 total interventions evaluated). The primary safety end point was the combination of any perforation, dissection, tamponade, or death. ELCA use per 10 000 interventions was evaluated for the study duration. Subgroups of interest were identified including in-stent restenosis lesions, saphenous vein graft lesions, chronic total occlusions, and thrombotic lesions. Results: A total of 19 688 lesions were identified with ELCA use (0.3% of all lesions). The rate of ELCA use increased across the study period from 14 ELCAs performed per 10 000 interventions in 2009 to 70 ELCAs performed per 10 000 interventions in 2018. The primary safety end point occurred in 4.2% of lesions and was higher than in cases where no ELCA was used (3.0% P<0.001). After adjusting for baseline differences among the subgroups who received ELCA, the in-stent restenosis group had the lowest rate of complications (odds ratio, 0.51 [95% CI, 0.42-0.63]), followed by the saphenous vein graft group (odds ratio, 0.72 [95% CI, 0.5-1]). The chronic total occlusion group had a higher risk for complications (odds ratio, 2.01 [95% CI, 1.61-2.40]). Conclusions: The use of ELCA has remained low but has increased in recent years. Complications are significantly higher when ELCA is used, but this effect is variable with respect to lesion subtype. ELCA is frequently used to treat in-stent restenosis with a low risk of complication. ELCA use during chronic total occlusion interventions is associated with a 2-fold increased risk of complications. Together these findings provide guidance for lesion selection to optimize safety with ELCA use.