Coronary Perforation and Late Pseudoaneurysm Outcomes After Excimer Laser Angioplasty.

BACKGROUND: Excimer laser coronary angioplasty (ELCA) is used in complex percutaneous coronary intervention (PCI). ELCA-related coronary artery perforation (CAP) is uncommon, and its long-term outcomes remain poorly defined.

AIM: The aim of this study was to characterize the long-term clinical and angiographic course of ELCA-related CAP.

METHODS: We retrospectively reviewed 1023 consecutive ELCA-assisted PCI procedures. CAP incidence was assessed, and the clinical and procedural features of CAP and non-CAP cases were compared. The predictors of CAP were explored using univariable logistic regression analysis. All patients with CAP underwent follow-up angiography, and CAP was graded using the Ellis criteria. Pseudoaneurysm (PsA)-defined as a contrast-filled outpouching with delayed washout-was confirmed using intravascular ultrasound/optical coherence tomography.

RESULTS: CAP occurred in 10/1023 procedures (1.0%). Baseline characteristics, including age, sex, and acute coronary syndrome presentation, were similar between the groups. ELCA catheter sizes and nominal laser settings were also comparable. Bifurcation lesions were more frequent in patients with CAP than in those without CAP (8/10 [80.0%] vs. 335/1013 [32.8%]; p = 0.002). Diabetes mellitus was also more common (7/10 [70.0%] vs. 376/1013 [37.1%]; p = 0.033). No in-hospital deaths were observed in the CAP group. At the index event, 6/10 CAP cases received a covered stent (CS) and 4/10 did not. On follow-up angiography (median 65 days; range 11-790 days), PsA was present in 4/4 non-CS patients and 0/6 CS patients.

CONCLUSIONS: CAP occurred in 1.0% of patients, and PsA developed in every non-CS case. These findings support planned follow-up imaging for selected ELCA-related perforations.