![]() Expansion and implosion of these bubbles disrupts the obstructive intra-vascular material (photomechanical). It elevates the temperature of intra-cellular water, causing cellular rupture and generates a vapour bubble at the catheter tip (photo-thermal). UV laser light is absorbed by intra-vascular material and breaks carbon–carbon bonds (photochemical). HO:YAG = holmium yttrium aluminium garnet Nd:YAG = neodymium-doped yttrium aluminium garnet XeCl = xenon chloride.Įxcimer laser tissue ablation is mediated through three distinct mechanisms: photochemical, photo-thermal and photomechanical. The major limitation is presence of heavy calcification although when rotational atherectomy (RA) is required but cannot be applied due to inability to deliver the dedicated RotaWire TM (Boston Scientific), ELCA can create an upstream channel to permit RotaWire passage and complete the case with RA – the RASER technique. Additionally, the technique can be mastered by any operator after a short period of training. The key advantage of ELCA over alternative atherectomy interventions is delivery on a standard 0.014-inch guidewire. The role of ELCA during PCI for thrombus, non-crossable or non-expandable lesions, chronic occlusions and stent under-expansion are discussed in this review. Technical aspects have evolved and there is an established safety and efficacy record across a number of clinical indications in contemporary interventional practice where complex lesions are routinely encountered. Excimer laser coronary atherectomy (ELCA) is a long-established adjunctive therapy that can be applied during percutaneous coronary intervention (PCI).
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