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Thrombus vaporization by excimer laser angioplasty
Cardiovascular Revascularization Medicine 11 (2010) 67 – 68
Image of the Issue
Thrombus vaporization by excimer laser angioplasty Gregory Angelo Sgueglia⁎, Giampaolo Niccoli, Marcello Marino, Filippo Crea Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy Received 13 May 2009; accepted 26 May 2009
A 70-year-old woman, with no traditional cardiovascular risk factor, came to our attention because of a non-STsegment myocardial infarction. Her cardiac history was uneventful, except the recent onset of episodes of waxing and waning epigastric pain. Of note, 2 weeks earlier, she began therapy with enoxaparin due to the suspicion of deep vein thrombosis. At admission, the patient complained of sharp, persisting pain referred to the epigastrium. Physical examination and routine blood test results were normal. Cardiac enzymes were raised (CK-MB 22.8 ng/ml) and ECG showed diffuse repolarization abnormalities. At echocardiography, mild depression of left ventricle function was found, with hypokinesis of its anterior and lateral walls. Coronary angiography (Fig. 1) revealed a critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (Panel A), thus prompting for percutaneous revascularization in the same session. After wiring of the culprit vessel, excimer laser angioplasty was performed (Panel B). Thrombus vaporization and underlying plaque debulking
⁎ Corresponding author. Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy. E-mail address: [email protected] (G.A. Sgueglia). 1553-8389/09/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.carrev.2009.05.004
were concurrently obtained (Panel C). The intervention was eventually completed with bare metal stenting for stabilization of the lesion. Procedure success was achieved with optimal percutaneous coronary flow and myocardial perfusion (Panel D). Excimer laser angioplasty is a promising application for a simple and effective handling of highly thrombotic coronary lesions. Its main features include rapid removal of thrombus, reduced risk of distal embolization, debulking of the underlying plaque, and facilitation of balloon angioplasty and/or stenting. Furthermore, decreased platelet aggregation has been described after the interaction of laser beam with platelets, the so-called stunned platelets phenomenon [1]. Reference [1] Topaz O, Minisi AJ, Bernardo NL, McPherson RA, Martin E, Carr SL, Carr ME. Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet” phenomenon. Thromb Haemost 2001;86:1087–93.
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G.A. Sgueglia et al. / Cardiovascular Revascularization Medicine 11 (2010) 67–68
Fig. 1. All images are left coronary angiograms in right anterior oblique caudal view. (A) Critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (arrow). (B) Excimer laser catheter at work in the culprit vessel (arrow shows the catheter distal radiopaque marker). (C) Culprit vessel after thrombus vaporization and underlying plaque debulking concurrently obtained by excimer laser. (D) Final result showing optimal percutaneous coronary flow and myocardial perfusion.
Image of the Issue
Thrombus vaporization by excimer laser angioplasty Gregory Angelo Sgueglia⁎, Giampaolo Niccoli, Marcello Marino, Filippo Crea Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy Received 13 May 2009; accepted 26 May 2009
A 70-year-old woman, with no traditional cardiovascular risk factor, came to our attention because of a non-STsegment myocardial infarction. Her cardiac history was uneventful, except the recent onset of episodes of waxing and waning epigastric pain. Of note, 2 weeks earlier, she began therapy with enoxaparin due to the suspicion of deep vein thrombosis. At admission, the patient complained of sharp, persisting pain referred to the epigastrium. Physical examination and routine blood test results were normal. Cardiac enzymes were raised (CK-MB 22.8 ng/ml) and ECG showed diffuse repolarization abnormalities. At echocardiography, mild depression of left ventricle function was found, with hypokinesis of its anterior and lateral walls. Coronary angiography (Fig. 1) revealed a critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (Panel A), thus prompting for percutaneous revascularization in the same session. After wiring of the culprit vessel, excimer laser angioplasty was performed (Panel B). Thrombus vaporization and underlying plaque debulking
⁎ Corresponding author. Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy. E-mail address: [email protected] (G.A. Sgueglia). 1553-8389/09/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.carrev.2009.05.004
were concurrently obtained (Panel C). The intervention was eventually completed with bare metal stenting for stabilization of the lesion. Procedure success was achieved with optimal percutaneous coronary flow and myocardial perfusion (Panel D). Excimer laser angioplasty is a promising application for a simple and effective handling of highly thrombotic coronary lesions. Its main features include rapid removal of thrombus, reduced risk of distal embolization, debulking of the underlying plaque, and facilitation of balloon angioplasty and/or stenting. Furthermore, decreased platelet aggregation has been described after the interaction of laser beam with platelets, the so-called stunned platelets phenomenon [1]. Reference [1] Topaz O, Minisi AJ, Bernardo NL, McPherson RA, Martin E, Carr SL, Carr ME. Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet” phenomenon. Thromb Haemost 2001;86:1087–93.
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G.A. Sgueglia et al. / Cardiovascular Revascularization Medicine 11 (2010) 67–68
Fig. 1. All images are left coronary angiograms in right anterior oblique caudal view. (A) Critical stenosis of the ramus intermedius with a high thrombus burden downward the lesion (arrow). (B) Excimer laser catheter at work in the culprit vessel (arrow shows the catheter distal radiopaque marker). (C) Culprit vessel after thrombus vaporization and underlying plaque debulking concurrently obtained by excimer laser. (D) Final result showing optimal percutaneous coronary flow and myocardial perfusion.