Excimer LASER Coronary Atherectomy in Complex Coronary Lesions: A Contemporary Analysis of Technical Success and Safety

Dr. Arunachalam Esakkiappan, Dr. Vijesh Anand Latha Arivudai Nambi, Dr. K Sureshkumar, Dr. P C Ganapathy Shakthivel

Abstract: Background: Complex coronary lesions, particularly in-stent restenosis (ISR), balloon non crossable and balloon non dilatable lesions, moderately calcified plaques, thrombotic lesions remain major challenges in percutaneous coronary intervention (PCI). Excimer laser coronary atherectomy (ELCA) has re-emerged as a valuable tool in such scenarios. Aim: To evaluate the immediate outcomes, safety, and technical success of ELCA in a contemporary cohort of patients with complex coronary artery disease. Methods: Fourteen patients undergoing ELCA between April to July 2025 were analysed. Baseline demographics, lesion characteristics, procedural details, and complications were reviewed. Technical success was defined as successful lesion modification permitting subsequent balloon angioplasty and/or stent deployment with TIMI 3 flow. Results: The mean age was 62.9 ? 8.5 years; 92.9% had diabetes mellitus, and 50% had chronic kidney disease. Most patients (78.6%) presented with ISR, and 28.6% had calcified lesions. The LAD was the most commonly involved vessel (64.3%). Clinical presentations included NSTEMI (35.7%), anterior wall MI (21.4%), and unstable angina (21.4%). Lasing techniques varied, with saline?blood? saline contrast mix 50%. Coronary dissections occurred in 78.6% (mostly Grade II), and slow flow in 57.1%; all were managed successfully. No major adverse cardiac events occurred peri-procedurally. Optical Coherence Tomography imaging was used in assisting. Technical success and complete revascularization were achieved in 100% of patients. Conclusions: In this case series, ELCA demonstrated universal technical success and acceptable safety in highly complex lesions, particularly ISR, balloon non crossable and calcified plaques. These results support ELCA as a valuable adjunctive strategy in contemporary PCI.

Keywords: Complex coronary lesions, Excimer LASER atherectomy, in stent restenosis, percutaneous coronary interventions

How to Cite?: Dr. Arunachalam Esakkiappan, Dr. Vijesh Anand Latha Arivudai Nambi, Dr. K Sureshkumar, Dr. P C Ganapathy Shakthivel, "Excimer LASER Coronary Atherectomy in Complex Coronary Lesions: A Contemporary Analysis of Technical Success and Safety", Volume 14 Issue 12, December 2025, International Journal of Science and Research (IJSR), Pages: 184-190, https://www.ijsr.net/getabstract.php?paperid=SR251202113106, DOI: https://dx.doi.org/10.21275/SR251202113106