Christy Rajan

St.Gregorios Medical Mission Hospital

Title: OCT-Guided Excimer Laser Atherectomy for Complex In-Stent Restenosis: A Case-Based Insight

Biography

Christy Rajan is a highly experienced Senior Cardiovascular Technologist with over nine years of specialized expertise in interventional cardiology. He currently serves at St. Gregorios Medical Mission Hospital, Parumala, where he plays a key role in cardiac catheterization, complex angioplasty support, and advanced cardiovascular imaging techniques, including ELCA, IVUS, OCT, and TAVR.

Christy’s clinical career spans several leading healthcare institutions, including Apollo Adlux Hospital and West Fort Hi-Tech Hospital, where he has been recognized for his precision in cath lab procedures and his adept handling of cutting-edge cardiovascular equipment. His commitment to patient safety, procedural accuracy, and collaborative care has earned him a reputation for excellence in the field.

He holds a Bachelor of Science in Cardiovascular Technology from Singhania University and is certified in both Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS). His core competencies include hemodynamic monitoring, arrhythmia detection, and support for device implantation procedures.

Abstract

In-stent restenosis (ISR) continues to pose significant clinical challenges, particularly in patients undergoing staged interventions for multivessel disease. We report a case from Parumala Heart Institute demonstrating the use of Excimer Laser Coronary Atherectomy (ELCA) guided by Optical Coherence Tomography (OCT) in managing ISR.

A male patient presented with an acute inferior wall myocardial infarction (STEMI) and underwent successful primary percutaneous coronary intervention (PCI) to the right coronary artery (RCA). Two weeks later, the patient returned for a staged procedure targeting ISR in the left anterior descending (LAD) artery.

An OCT-guided approach was employed to optimize lesion preparation and treatment strategy. A 1.4 mm Philips ELCA catheter was used to perform the initial laser atherectomy run. OCT imaging post- procedure revealed effective plaque modification in the distal segment but highlighted residual proximal plaque. A second targeted laser run addressed the proximal plaque. Follow-up OCT confirmed satisfactory lesion modification throughout the stented segment.

Subsequent high-pressure dilatation with a non-compliant (NC) balloon achieved appropriate lumen gain. A Paclitaxel-coated drug-coated balloon (Prevail™ DCB) was deployed, culminating in a final angiographic result with TIMI III flow and excellent vessel patency.

This case underscores the value of image-guided atherectomy in ISR management and exemplifies how combining ELCA with OCT and DCB therapy can achieve optimal clinical outcomes with minimal additional stent layers. Such approaches are particularly beneficial in centres focused on precision PCI and long-term vessel preservation.