Figure 5: The use of Excimer Laser Coronary Atherectomy in a Calcific Undilatable Lesion.

A 69-year-old man with a severe calcific lesion in the proximal portion of a dominant right coronary artery (A). Despite use of a 3.0 x 20-mm noncompliant balloon at high pressure, there was clear failure of lesion expansion (B). Excimer laser atherectomy was undertaken with a 0.9- mm X80 catheter, delivering 5,000 pulses over 15 trains. This caused a small proximal localised dissection, but allowed balloon expansion (C) and subsequent treatment with overlapping drug-eluting stents (D).