Combined Rotational Excimer lASER Coronary Atherectomy (RASER) in Non-crossable, Non-dilatable Coronary Artery Disease: Observations From a Single Center: An Interview with Farhan Shahid, PhD

Dr Farhan Shahid shares background and insights on his paper, “Combined Rotational Excimer lASER Coronary Atherectomy (RASER) in Non-crossable, Non-dilatable Coronary Artery Disease: Observations From a Single Center.” Read the article here.

Transcript:

Thank you very much Journal of Invasive Cardiology for inviting me to talk on my recent paper. My name is Dr Farhad Shahid. I am an interventional cardiologist at the Heart and Lung Transplant Unit in Birmingham named Queen Elizabeth Hospital and I am here today to talk about my paper, entitled Combined Rotational Excimer lASER Coronary Atherectomy (RASER) in Non-crossable, Non-dilatable Coronary Artery Disease: Observations From a Single Center.

00:30: What inspired your group to initiate this study?

It’s a great question. So as the years have gone on, we've got an aging population - our patients are living longer. Our patients are having an increased list of comorbidities now. and also comes with that an increased risk of all forms of cardiological intervention. And so what we notice in our center is that a lot more patients now who are going to our heart team for discussion after suffering a coronary event of any kind, be it angina, not responding to conventional therapies, or are acute coronary syndromes are being discussed with an increasing of age and increasing frailty, increase in comorbidities, and also having previous coronary bypass grafting or complex interventions in their history. And so what inspired this study is finding that we were having to undertake interventions now on patients that have made a choice of actually declining surgery, not because of anything more than the risk that is quoted to them, and therefore we undertaking such complex patients. And therefore we looked at what adjuvant therapies are using and what their success has been like.

01:36: Did any of the results of the study surprise you? What were the most striking results of the study to your group?

So when we looked into our use of our RASER technique as described, which is the use of rotational atherectomy but preceding this with laser therapy, which is our ultrasound wavelength pulse waves to form a pilot hole in calcified lesions which are non-crossable, non-dilatable. What was initially surprising to a certain extent is that we are really taking on high-risk patients – fifty percent of the group that were in our cohort therapy were actually diabetic, which in itself is a as a risk factor for coronary disease and also risk in terms of procedural success, but also 20% had previous coronary bypass grafting. So it's quite surprising that we were taking on such a cohort, but also a bit more pleasantly surprising was that we had an 82% success rate in such a cohort of delivering our percutaneous intervention in the form of stent insertion, and also with the use of these 2 adjuvant therapies to help proceed on to percutaneous intervention, we found our operators were actually leading to a slightly more fuller revascularization, because we were augmenting these calcified vessels in a more thorough manner, and actually our average stent insertion within the vessel was actually longer than where we did not use the RASER technique. So quite refreshing to see that the success rate was high in these high-risk patients. But also there's an element, or a highlight of possible, more complete revascularization

03:10: Based on the results of this study, is there anything you'd like to research further?

I think over the 14-year period that we did look back through our retrospective study, what's very clear within the in the kind of window of percutaneous intervention in this space is that the use of intracoronary imaging has really taken bounds over that period of time, and we've probably not captured in that period what we're really doing with intravascular imaging now, because that's been over the last few years. So going forward, what would be very interesting will be very hypothesis-generating is that with the use of intravascular ultrasound, now that we use and optical coherence technologies, is, there is no doubt that this improves patient outcomes when using these intracoronary techniques and along with RASER, if we combine the two together, I'm sure that we can actually improve our success rates and long-term outcomes in this highly complex population. And so going forward, that will be something to explore even further in.

04:08: For cardiologists who are new to RASER, can you describe cases that may particularly benefit from this technique?

Yes. So the RASER technique is not something we're going to use in everyday practice it very much is a highly select population. Those patients in which are commonly having highly calcified vessels, the coronary patients that taken to our heart meetings, not deemed suitable forms of intervention, such as bypass surgery, for instance. So this population will be in that cohort, and furthermore, the actual technique itself will be used in those areas where despite being able to pass our normal wires through these vessels, we are not able to deliver the adjuvant therapies in terms of pre-dilation with our conventional balloons, and therefore in this population would lead to a sub optimal end result in terms of standard insertion, because we wouldn't be able to augment the calcium and prepare the vessel appropriately. And that's where the RASER technique can potentially be very beneficial.

05:08: What can we look forward to seeing next from your group?

Well, being in one of the large heart and lung transplant centers, what we'd like to do now going forward is, we have, as I've stated before, an increased use of intracoronary imaging now. Also on the market, has come over the years, while we are doing this retrospect study intravascular lithotripsy, or shockwave therapy, is now very much on the market in the last few years, along with rotational atherectomy in the form of orbital, and these techniques will be also very interesting to see along with imaging in this high-risk group is whether or not we actually further improve our outcomes with the use of other adjuvant therapies that are now there. And therefore, as the population is aging and more comorbidities, and we're going to see a lot more cases such as this is whether or not we have these new adjuvant therapies. The marketing can even improve our long-term outcome of these complex patients furthermore.