# Angioscopic Evaluation of In-Stent Occlusion in the Superficial Femoral Artery Treated With Excimer Laser Atherectomy

## TL;DR

This paper evaluates how excimer laser atherectomy affects in-stent occlusion in the superficial femoral artery using advanced imaging techniques.

## Contribution

The first report to use multimodal imaging, including real-time angioscopy, to assess ELA effects on in-stent occlusion.

## Key findings

- ELA effectively dissipated thrombus and inflammatory tissue in ISO lesions.
- ELA had limited effect on vaporizing the proximal cap and neointimal hyperplasia.
- Multimodal imaging provided detailed insights into ELA's differential effects on ISO components.

## Abstract

In-stent occlusion (ISO) comprises various components, including thrombus and neointimal hyperplasia, but its detailed characteristics and treatment responses remain unclear.

We performed excimer laser atherectomy (ELA) to treat an ISO in the superficial femoral artery. Multimodal imaging, including intravascular ultrasound, optical coherence tomography, and angioscopy, enabled detailed procedural assessment. Additionally, real-time angioscopy was performed from a contralateral approach during the ELA procedure to observe its effects dynamically. The results showed that although ELA had a limited effect on vaporizing the proximal cap and neointimal hyperplasia, it successfully dissipated thrombus and inflammatory tissue.

This is the first report to evaluate the effects of ELA on ISO lesions using multimodal imaging, including real-time angioscopy. This approach provides new insights into the potential benefits of ELA in endovascular therapy.

ISO contains various components, including thrombus and neointimal hyperplasia. ELA demonstrated differential effects on each component.