Coronary Perforation After Excimer Laser Coronary Angioplasty at a Calcium Nodule

J INVASIVE CARDIOL 2020;32(8):E226-E227. 

Key words: coronary perforation, calcification, excimer laser coronary angioplasty

Percutaneous coronary intervention of 3 severely calcified lesions in the right coronary artery (RCA) (Figure 1A) was performed with excimer laser coronary angioplasty (ELCA; 0.9 mm, Spectranetics) using saline injection, fluence at 80 mJ/mm², and frequency at 80 Hz (Figure 1B). Subsequently, an Ellis I perforation was observed at the proximal RCA (Figure 1C), with immediate progression to Ellis III (Figure 1D). Prolonged balloon inflation (Figure 1E) and drug-eluting stent  implantation (Figure 1F) sealed the perforation. Afterward, two drug-eluting stents were successfully implanted at distal lesions (Figure 2A). Optical coherence tomography (OCT) confirmed the result of these stents (Figures 2B-2G) and depicted the perforation site (Figures 2C and 2F), the crater (Figure 2D), and a calcium nodule proximal to the perforation (Figures 2E and 2F). 

ELCA is one of the interventional tools for calcified coronary lesions. It photoablates the atherosclerotic plaque even if it is located underneath hard tissue. Our findings show that ELCA could be helpful in treating severely calcified lesions; however, a small risk of perforation exists, especially if ELCA is applied at a calcium nodule. To our knowledge, this is the first OCT description of this complication. 

From the Cardiology Department, La Paz University Hospital, Madrid, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted December 26, 2019.

Address for correspondence: Alfonso Jurado-Román, MD, PhD, Cardiology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain. Email: alfonsojuradoroman@gmail.com