Laser Application in Severe Stent Underexpansion

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J INVASIVE CARDIOL 2025. doi:10.25270/jic/25.00360. Epub December 1, 2025.

Excimer laser coronary atherectomy (ELCA) is among the treatment modalities applied for stent underexpansion. We present the clinical images of a patient with severe stent underexpansion treated successfully with lasing under contrast administration.

A 73-year-old man with known history of arterial hypertension and diabetes mellitus was referred to our hospital for coronary angiography because of unstable angina. A stent had been implanted in his first obtuse marginal branch (OM1) 5 months prior.

Coronary angiography showed a severely underexpanded stent in the OM1, confirmed by stent boost and caused by calcification (Figure 1A and B). Advancement of intravascular ultrasound (IVUS) through the stenosis was not feasible. Dilatations with noncompliant balloons failed to expand the previously implanted stent (Figure 1C). It was decided to proceed with ELCA (Philips). Although lasing with a 0.9-mm catheter under saline injection failed, subsequent lasing under contrast injection achieved lesion ablation (Figure 2A, Video 1, Video 2). A noncompliant balloon was then dilated symmetrically, allowing adequate stent expansion illustrated by stent boost and IVUS (Figure 2B-E).

ELCA uses ultraviolet energy (wavelength: 308 nm) delivered by a xenon-chlorine pulsed laser catheter with pulse frequency of 25 to 80 Hz and fluence of 30 to 80 mJ/mm², leading to disruption and disintegration of the molecular bonds within the atherosclerotic plaque in a highly controlled manner through ablation rather than burning.¹ Compared with atherectomy devices, it has the advantage that it can be advanced through a standard 0.014-inch guidewire and can modify the lesion without crossing it. Lasing with saline is in general safer and is preferred; however, activation with simultaneous contrast injection creates a powerful acoustic mechanical effect with the formation of multiple large-sized bubbles that can effectively debulk and soften calcium, leading to stent expansion in case the former technique fails.^2-4

Iosif Xenogiannis, MD, PhD¹; Efthymia Varytimiadi, MD, MSc²; Aggeliki Rigatou, MD, PhD²; Michael Koutouzis, MD, PhD²

From the ¹Department of Cardiology, Mitera General Hospital, Hygeia HealthCare Group, Athens, Greece; ²Sixth Cardiology Clinic, Hygeia Hospital, Hygeia HealthCare Group, Athens, Greece.

Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.

Consent statement: The authors confirm that informed consent was obtained from the patient for the intervention described in the manuscript and for the publication of his/her data/thereof, including any and all images

Address for correspondence: Iosif Xenogiannis, MD, PhD, Mitera General Hospital, Hygeia HealthCare Group, 6 Erythrou Stavrou Street, Marousi, Attica 15123, Greece. Email: iosifxeno@hotmail.com