Intravascular ultrasound assessment of the effect of laser energy on the arterial wall during the treatment of femoro-popliteal lesions: a CliRpath excimer laser system to enlarge lumen openings (CELLO) registry study.
Intravascular ultrasound assessment of the effect of laser energy on the arterial wall during the treatment of femoro-popliteal lesions: a CliRpath excimer laser system to enlarge lumen openings (CELLO) registry study.
- 2018
The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5+/-3.2-mm2 (95% CI 4.3-6.8, p<0.0001) and reduction in plaque plus media volume of -10.6+/-36.0 mm3 (95% CI -25.8 to 4.6, p=0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury.
English
1569-5794
*Atherectomy/is [Instrumentation]
*Endovascular Procedures/is [Instrumentation]
*Femoral Artery/su [Surgery]
*Lasers, Excimer/tu [Therapeutic Use]
*Peripheral Arterial Disease/su [Surgery]
*Popliteal Artery/su [Surgery]
*Ultrasonography, Interventional
Aged
Atherectomy/ae [Adverse Effects]
Endovascular Procedures/ae [Adverse Effects]
Female
Femoral Artery/dg [Diagnostic Imaging]
Femoral Artery/in [Injuries]
Hematoma/dg [Diagnostic Imaging]
Hematoma/et [Etiology]
Humans
Lasers, Excimer/ae [Adverse Effects]
Male
Middle Aged
Peripheral Arterial Disease/dg [Diagnostic Imaging]
Plaque, Atherosclerotic
Popliteal Artery/dg [Diagnostic Imaging]
Popliteal Artery/in [Injuries]
Predictive Value of Tests
Prospective Studies
Registries
Treatment Outcome
United States
Vascular System Injuries/dg [Diagnostic Imaging]
Vascular System Injuries/et [Etiology]
MedStar Heart & Vascular Institute
Journal Article
The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5+/-3.2-mm2 (95% CI 4.3-6.8, p<0.0001) and reduction in plaque plus media volume of -10.6+/-36.0 mm3 (95% CI -25.8 to 4.6, p=0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury.
English
1569-5794
*Atherectomy/is [Instrumentation]
*Endovascular Procedures/is [Instrumentation]
*Femoral Artery/su [Surgery]
*Lasers, Excimer/tu [Therapeutic Use]
*Peripheral Arterial Disease/su [Surgery]
*Popliteal Artery/su [Surgery]
*Ultrasonography, Interventional
Aged
Atherectomy/ae [Adverse Effects]
Endovascular Procedures/ae [Adverse Effects]
Female
Femoral Artery/dg [Diagnostic Imaging]
Femoral Artery/in [Injuries]
Hematoma/dg [Diagnostic Imaging]
Hematoma/et [Etiology]
Humans
Lasers, Excimer/ae [Adverse Effects]
Male
Middle Aged
Peripheral Arterial Disease/dg [Diagnostic Imaging]
Plaque, Atherosclerotic
Popliteal Artery/dg [Diagnostic Imaging]
Popliteal Artery/in [Injuries]
Predictive Value of Tests
Prospective Studies
Registries
Treatment Outcome
United States
Vascular System Injuries/dg [Diagnostic Imaging]
Vascular System Injuries/et [Etiology]
MedStar Heart & Vascular Institute
Journal Article