Small 0.7 mm diameter laser catheter for chronic total occlusions, small vessels, tortuous anatomy, and balloon-resistant lesions - development and initial experience.

Excimer laser coronary atherectomy (ELCA) has been an FDA-approved treatment for coronary artery disease since 1992 and is commonly used as an adjunct treatment to balloon angioplasty. While ELCA presents a good therapeutic option for lesions non-dilatable or uncrossable with balloon angioplasty, historically the technique was not able to manage heavily calcified lesions. The advent of a smaller (0.9 mm tip diameter) excimer laser coronary catheter (Point 9, Spectranetics Corporation), capable of delivering higher energy densities and repetition rates, has proven effective and safe in the treatment of complex calcified lesions1-3. However, there is still a need for a smaller laser catheter for use in small vessels in other anatomical locations, balloon-resistant lesions, and for primary crossing of CTOs. We recently developed a new, even smaller over-the-wire (OTW) laser catheter (Point 7) capable of accessing the most distal vasculature and providing an additional margin of safety in treating complex lesions. Combined with a simple guidewire steering element this device could possibly be used to traverse the proximal cap of CTOs and assist in the primary crossing of the blockage.