Excimer laser atherectomy for uncrossable coronary lesions and improperly deployed coronary stents /

The TAU was asked to review the use of excimer laser for atherectomy using the Spectranetics CVX-300 xenon-chlorine excimer laser and associated catheters in two specific uncommon situations: i) in which the deflated balloon could not pass through the lesion (uncrossable lesion, <1% of lesions), and ii) in which an implanted stent did not expand to its full diameter (improperly deployed/underexpan [...] This is used with the currently available catheter models, the ELCA Coronary Laser Atherectomy Catheter4, designed for coronary laser atherectomy, and the Turbo Elite laser atherectomy catheter5, primarily designed for treatment of peripheral vascular stenoses. [...] The two models of catheter have similar designs (circular or eccentric, wire-exchangeable and over the wire), but the Turbo Elite delivers higher energy than the ELCA models, with the exception of the ELCA X-80. [...] The request considers the cost of the catheters only (ELCA Coronary Laser Atherectomy Catheter), as the laser generator itself is available by previous arrangement between the MUHC and the manufacturers. [...] We therefore calculated costs in two situations (a) the catheter is used as part of the initial procedure, and the only additional cost is the catheter, (b) the catheter is used in a repeat procedure, and the total cost is that of the repeat procedure including catheter.