Three-Year Clinical Outcomes of IVUS-Guided Excimer Laser Coronary Atherectomy for In-Stent Restenosis

IF 1.4 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of interventional cardiology Pub Date : 2026-06-16 DOI:10.1155/joic/3301068

Keisuke Matsuo, Takahide Arai, Mitsunobu Nagai, Hiroki Hoya, Yodo Gatate, Shintaro Nakano

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Abstract

Background

In-stent restenosis (ISR) remains challenging after percutaneous coronary intervention (PCI) using drug-eluting stents, often leading to target lesion revascularization (TLR) and major adverse cardiovascular and cerebrovascular events (MACCEs). Excimer laser coronary atherectomy (ELCA) removes neointimal tissue and preserves minimum lumen area (MLA); however, its long-term benefits are unclear.

Aims

We assessed the 3-year outcomes of PCI with or without ELCA for ISR and examined prognostic factors and intravascular ultrasound (IVUS) findings.

Methods

We retrospectively analyzed data of 97 patients with ISR among 2083 consecutive patients who underwent PCI between April 2020 and March 2025. Patients were divided into ELCA (n = 44) and non-ELCA (n = 53) groups. Outcomes were analyzed using Kaplan–Meier and log-rank tests. The primary outcome was all-cause mortality. Secondary outcomes included TLR and MACCE rates. IVUS characteristics were also assessed.

Results

Baseline characteristics were generally similar between groups, although acute coronary syndrome was more frequent in the non-ELCA group. All-cause mortality did not differ significantly between groups (p = 0.699). TLR was numerically lower in the ELCA group (0% vs. 7.5%, p = 0.062). MACCEs were significantly less frequent in the ELCA group (2.3% vs. 18.9%, p = 0.018), and ELCA was independently associated with a lower risk of MACCEs in multivariable Cox analysis. After IPW, ELCA remained significantly associated with a lower risk of MACCEs (odds ratio 0.065, 95% confidence interval 0.006–0.291, p = 0.003). However, event-specific analyses, particularly for TLR, were limited by sparse events and should be interpreted cautiously. IVUS showed significantly greater lumen enlargement in the ELCA group, and the change in MLA correlated with baseline minimum stent area only in the ELCA group.

Conclusions

In this retrospective cohort, ELCA was associated with lower MACCE rates and greater lumen enlargement; however, these findings should be considered hypothesis-generating in light of the nonrandomized design, limited sample size, and imbalance in clinical presentation.

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ivus引导的准分子激光冠状动脉粥样硬化切除术治疗支架内再狭窄的三年临床结果

背景：使用药物洗脱支架进行经皮冠状动脉介入治疗（PCI）后，支架内再狭窄（ISR）仍然具有挑战性，经常导致靶病变血运重建术（TLR）和主要的不良心脑血管事件（MACCEs）。准分子激光冠状动脉粥样硬化切除术（ELCA）去除新内膜组织并保留最小管腔面积（MLA）；然而，其长期效益尚不清楚。我们评估了伴有或不伴有ELCA的PCI治疗ISR的3年结果，并检查了预后因素和血管内超声（IVUS）结果。方法回顾性分析2020年4月至2025年3月期间连续接受PCI治疗的2083例患者中97例ISR患者的资料。患者分为ELCA组（n = 44）和非ELCA组（n = 53）。结果分析采用Kaplan-Meier检验和log-rank检验。主要结局为全因死亡率。次要结局包括TLR和MACCE率。IVUS特征也进行了评估。结果两组间的基线特征基本相似，但非elca组的急性冠脉综合征发生率更高。两组间全因死亡率无显著差异（p = 0.699）。ELCA组TLR数值较低（0% vs. 7.5%, p = 0.062）。在多变量Cox分析中，ELCA组MACCEs发生率显著降低（2.3% vs. 18.9%, p = 0.018）， ELCA与MACCEs风险降低独立相关。IPW后，ELCA仍与MACCEs的较低风险显著相关（优势比0.065,95%置信区间0.006-0.291,p = 0.003）。然而，特定于事件的分析，特别是针对TLR的分析，受到稀疏事件的限制，应该谨慎解释。IVUS显示ELCA组的管腔增大明显增大，MLA的变化仅与ELCA组的基线最小支架面积相关。在这个回顾性队列中，ELCA与较低的MACCE发生率和较大的管腔增大有关；然而，考虑到非随机设计、有限的样本量和临床表现的不平衡，这些发现应该被认为是假设产生的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of interventional cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Interventional Cardiology is a peer-reviewed, Open Access journal that provides a forum for cardiologists determined to stay current in the diagnosis, investigation, and management of patients with cardiovascular disease and its associated complications. The journal publishes original research articles, review articles, and clinical studies focusing on new procedures and techniques in all major subject areas in the field, including: Acute coronary syndrome Coronary disease Congenital heart diseases Myocardial infarction Peripheral arterial disease Valvular heart disease Cardiac hemodynamics and physiology Haemostasis and thrombosis