laser in the management of coronary artery disease. a thrombotic lesion, difficulty to cross the lesion, in-stent restenosis, acute interventions in SVG graft.

1. Excimer Laser in CAD
KIMS experience
15 cases
Dr Rajendra Kumar Jain
Founder Director- KIMS
Head of Department-KIMS,HYD.

2. Elca-thrombotic SVG graft
65,male
CAD- ACS, Inferior wall MI+RVMI
Post CABG (2006), USA no details
CAG+ Graft Angio showed LMCA+Native Triple Vessel Disease
LIMA - LAD patent, RIMA occluded,
SVG - PLVB proximal total thrombotic occlusion
Severe LV Dysfunction
Primary PCI to SVG - PLVB

4. 5/8/21
6F AL I Guiding
Rinato wire
2.0 x 12 NC Balloon

5. 6/8/2021
3.0/48mm balloon
1.4mm Elca Laser, 0.9mm ELca Laser up to 40-80 Fluence

6. 7/8/21
SVG - PLVB distal 3.5 x 48 Xpedition
SVG - PLVB Mid 3.5 x 48 Xpedition
SVG - PLVB proximal 3.5 - 3.0 x 60 Morph Biomime

7. • ruzaria robert rca
isr

12. ELCA-instent restenosis
underexpanded stent
M R R 60Y/M
CAD - DOE FC II
TMT+ve, Post PTCA to RCA 3.5/40 Abluminus, (4-3-20)
DM, Mild LV dysfunction
ACS, NSTEMI (16/8/21)
CAG -ISR of RCA (16/8/21)
SM+, Post COVID 2020
1.5/6mm, 2.5/12 NC balloon
0.9mm ELCA Coronary Laser 60Fluence given
3.5/10, 3.5/20 DEB done

13. • ruzaria robert rca
isr

17. ELCA- Acute MI-thrombus
TS,35 mal3
• CAD - Anterolateral MI (06/09/2021)
Moderate LV Dysfunction, Cardiogenic Shock
TLT with Reteplase
CAG - Single Vessel Disease,
LAD Thrombotic Occlusion(7/9/21)
ELCA Laser and IVUS assisted PTCA 9/9/21 to LAD

19. CHECK ANGIO AFTER ONE MONTH

23. Elca- in stent restenosis
CKR 60 male
CAD - Anterior Septal MI, Post STK (29/01/2010)
Moderate LV Dysfunction
CAG - Two Vessel Disease (04/02/210)
PTCA STENT to Mid LAD (3/28mm DES) and OM (3/13mm BMS)
CAD - DOE FC -III (20/08/2021)
CAG - ISR of LAD, LCX 80% after OM stent,
DM+
ELCA assisted IVUS Guided PTCA to Mid - distal LAD and LCX
Post PTCA Re infarcation
Stent to Proximal LAD

24. 0.9mm ELCA Laser
60mJ/mm2 - 60Hz
2.5/10 Wolverine, 3.0/10
Wolverine Cutting Balloon
2.5/21 Ultimaster Tansei
STENT
2.5/10 OPN NC balloon@25
ATMS

25. Post PTCA Patient had chest pain with fresh ECG changes
Check angio done Thrombotic Lesion in Proximal LAD
3 x 24 Ultimaster Tansei STENT deployed in Proximal LAD

29. Elca-when nothing could cross
Two different hospitals
KRR
CAD - Post CABG (2010), LIMA - LAD, SVG- OM and RCA
CT CAG - 2019 Native TVD, Pattent Grafts
ACS - NSTEMI (06/08/2021), Goodl LV Function
CAG - 7/8/2021, Native TVD, LIMA - LAD Pattent,
SVG- OM and RCA occluded
Attempted PTCA to Native RCA (9/8/2021) unsuccessful (other hospital)
Recurrent Angina class II
3-09-2021 Chip PTCA to RCA attempted unsuccessful (other hospital)
4/10/2021 ELCA assisted Sucessful PTCA done in KIMS

30. 7F SAL -I Guiding
GIA - II Wire
6F Guide Plus
0.9mm ELCA Laser Cathter for Fluency 60mJ/mm2 & Frequency 60Hz with
Guideextention support
Pre Dilataion with 0.75/10mm Alveo HP , 1.5/10mm,
2.5/12mm, 3.0/18mm NC bllloon,
2.5/10 Angiosculpt Balloon

33. Elca- 25 yr old calcified SVG graft
restenosis
RK-76 male
POST CABG 1997
LIMA - LAD, SVG - OM, SVG- RCA
DM+
2006 CT ANGIO - SVG-RCA Occluded
PATENT SVG-OM, LIMA - LAD
31/5/21 CLASS III Angina, UA with ECG changes
CAG - 7-7-21 Native Triple Vessel Disease, Pattent LIMA - LAD
SVG-OM1 proximal 90% tight lesion
7-7-21 PTCA/STENT to SVG - OM, 3.0/28 ULTIMASTER TANSEI
ACS NSTEMI 16/2/22
Severe LV dysfunction

35. INDICATIONS
• ACS/MI
• Non-crossable/ Non-dilatable lesions (Balloon Failure)
• CTO
• Under-expanded stents
• ISR
• SVG
• Bifurcation lesions

36. CONTRAINDICATIONS
Unprotected LM
disease
Long subintimal
course of the
PCI wire (as in
CTOs)

37. TECHNIQUE
• XeCl active medium
• 308nm (UV-B)
• 30 mcm penetration depth
• Tinted glasses
• Catheter calibration
• Monorail
• 0.014 inch PCI wire
• Catheter sizes -0.9 1.4, 1.7, 2.0
• Depends on severity, vessel size, consistency of target
• Guide catheter 6F; 7F; 8F – coaxial
• Saline flush – 1-2ml/sec
• Fluence and PRF – cycles/ rest
• Advance slowly – 0.5mm/sec
• Several antegrade f/b retrograde if required

38. COMPLICATIONS
Similar to routine PCI
Inadequate saline
flush or contamination
with contrast 
Excessive heating 
Perforation

39. Thank you

40. Patient Devla Naik S 64Y/M
ACS, Unstable Angina 25/5/21
25-5-21 PTCA/STENT to LAD 3.0/28mm Evroflex
9-6-21 ACS NSTEMI
CAG- Patent LAD stent with D1 Thrombus
AOE FC II 3 months, Recurrent Angina
NSTEMI (21/10/21), SR, No CCF
22-10-21 CAG - ISR LAD
Good LV Function
1.0/5mm Balloon, 2.0/12NC balloon, 6F Telescope (Guide extention)
0.9mm ELCA
3.0/15mm, 3.5/15mm NC Balloon
3.5/38 Ultimaster STENT, 3.5/15 NC balloon,
Post STENT dilataion 4.5/08mm NC, 4.0/10 NC