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.

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Citation: The International Journal of Cardiovascular Imaging. 34(3):345-352, 2018 Mar.PMID: 28952037Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2018ISSN:
  • 1569-5794
Name of journal: The international journal of cardiovascular imagingAbstract: 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-mm<sup>2</sup> (95% CI 4.3-6.8, p<0.0001) and reduction in plaque plus media volume of -10.6+/-36.0 mm<sup>3</sup> (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.All authors: Azizi V, Beyene S, Bui A, CELLO study investigators, Desale S, Dheendsa A, Garcia-Garcia HM, Kajita AH, Koifman E, Kuku KO, Meirovich YF, Melaku G, Schneider B, Waksman RFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-09-29
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Journal Article MedStar Authors Catalog Article 28952037 Available 28952037

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-mm<sup>2</sup> (95% CI 4.3-6.8, p<0.0001) and reduction in plaque plus media volume of -10.6+/-36.0 mm<sup>3</sup> (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.

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