---
title: "Excimer Laser Angioplasty vs Aspiration Thrombectomy and Conventional PCI: Stratified Meta-analysis"
id: "pubmed-42736488"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42736488"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42736488/"
doi: "10.1007/s10103-026-05032-x"
published_at: "2026-09-15T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Excimer Laser Angioplasty vs Aspiration Thrombectomy and Conventional PCI: Stratified Meta-analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42736488
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42736488/)
- **DOI:** [10.1007/s10103-026-05032-x](https://doi.org/10.1007%2Fs10103-026-05032-x)
- **Published At:** 2026-09-15T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review and stratified meta-analysis evaluated adjunctive **excimer laser coronary angioplasty (ELCA)** versus **aspiration thrombectomy** (Stratum A) and versus **conventional PCI** alone (Stratum B) for acute coronary occlusion during primary PCI. - The review was registered (PROSPERO CRD420261422463) and included 10 studies (1 randomized trial and 9 observational studies) with an enrolled population exceeding 3,500 patients. - Primary angiographic endpoints were final **TIMI-3** flow and **myocardial blush grade (MBG) 3**; secondary outcomes included short-term mortality, MACCE, and slow-flow/no-reflow. - A random-effects model with Hartung-Knapp-Sidik-Jonkman confidence intervals was applied to all outcomes; certainty of evidence was assessed using GRADE and judged to be very low for all outcomes. - In Stratum A (ELCA + PCI versus aspiration thrombectomy + PCI), no outcome reached statistical significance: MBG-3 (OR 3.57, 95% CI 0.07–185.10), mortality (OR 0.31, 95% CI 0.02–4.04), MACCE (OR 0.22, 95% CI 0.04–1.26), TIMI-3 flow (OR 1.58, 95% CI 0.67–3.75), slow-flow/no-reflow (OR 0.78, 95% CI 0.22–2.78). - In Stratum B (ELCA-containing strategies versus PCI alone), using propensity-matched data from included studies, there were no significant differences: TIMI-3 flow (OR 0.88, 95% CI 0.38–2.03), MBG-3 (OR 1.06, 95% CI 0.13–8.43), slow-flow/no-reflow (OR 0.93, 95% CI 0.29–3.02), mortality (OR 0.44, 95% CI 0.05–3.80). - Composite endpoints were not pooled when follow-up horizons were incompatible across studies. - The meta-analysis concluded that adjunctive ELCA strategies during primary PCI were not associated with improved angiographic or short-term clinical outcomes compared with either aspiration thrombectomy or conventional PCI in acute coronary occlusion. - The authors emphasized that all outcomes were of very low certainty and recommended that multicenter randomized trials are needed before clinical adoption of ELCA as a routine adjunctive strategy.
## Clinical Analysis & Structured Key Points
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Habib.Khan@lhsc.on.ca.") Affiliations Expand ### Affiliations * 1 Faculty of Medicine, Cairo university, Giza, Egypt. * 2 Al-Andalus University for Medical Sciences, Tartus, Syrian Arab Republic. * 3 Faculty of Pharmacy, Badr University, Cairo, Egypt. * 4 Faculty of Medicine - Capital University (formerly Helwan University), Cairo, Egypt. * 5 Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada. * 6 Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada. Habib.Khan@lhsc.on.ca. # Contributed equally. * PMID: **42736488** * DOI: [ 10.1007/s10103-026-05032-x ](https://doi.org/10.1007/s10103-026-05032-x) Item in Clipboard Review # Excimer laser angioplasty for acute coronary occlusion: a stratified meta-analysis of efficacy against aspiration thrombectomy and conventional PCI Fouad Hanna et al. Lasers Med Sci. 2026. Show details Display options Display options Format Abstract PubMed PMID Lasers Med Sci Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Lasers+Med+Sci%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Lasers+Med+Sci%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42736488/) . 2026 Sep 15;41(1):232. doi: 10.1007/s10103-026-05032-x. ### Authors [Fouad Hanna](https://pubmed.ncbi.nlm.nih.gov/?term=Hanna+F&cauthor_id=42736488)[#](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-1 "Faculty of Medicine, Cairo university, Giza, Egypt."), [Ali Dway](https://pubmed.ncbi.nlm.nih.gov/?term=Dway+A&cauthor_id=42736488)[#](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-equal-contrib-explanation "Contributed equally")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-2 "Al-Andalus University for Medical Sciences, Tartus, Syrian Arab Republic."), [Sara T Zaki](https://pubmed.ncbi.nlm.nih.gov/?term=Zaki+ST&cauthor_id=42736488)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-3 "Faculty of Pharmacy, Badr University, Cairo, Egypt."), [Mazen Negmeldin Yassin](https://pubmed.ncbi.nlm.nih.gov/?term=Yassin+MN&cauthor_id=42736488)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-1 "Faculty of Medicine, Cairo university, Giza, Egypt."), [Abdelrahman El-Helbawy](https://pubmed.ncbi.nlm.nih.gov/?term=El-Helbawy+A&cauthor_id=42736488)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-4 "Faculty of Medicine - Capital University \(formerly Helwan University\), Cairo, Egypt."), [Luiz F Ybarra](https://pubmed.ncbi.nlm.nih.gov/?term=Ybarra+LF&cauthor_id=42736488)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-5 "Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada."), [Habib Rehman Khan](https://pubmed.ncbi.nlm.nih.gov/?term=Khan+HR&cauthor_id=42736488)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42736488/#short-view-affiliation-6 "Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada. Habib.Khan@lhsc.on.ca.") ### Affiliations * 1 Faculty of Medicine, Cairo university, Giza, Egypt. * 2 Al-Andalus University for Medical Sciences, Tartus, Syrian Arab Republic. * 3 Faculty of Pharmacy, Badr University, Cairo, Egypt. * 4 Faculty of Medicine - Capital University (formerly Helwan University), Cairo, Egypt. * 5 Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada. * 6 Department of Medicine, Division of Cardiology, London Heart Rhythm Program, Ontario, London, Canada. Habib.Khan@lhsc.on.ca. # Contributed equally. * PMID: **42736488** * DOI: [ 10.1007/s10103-026-05032-x ](https://doi.org/10.1007/s10103-026-05032-x) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract Primary percutaneous coronary intervention (PCI) achieves epicardial reperfusion in most STEMI patients, yet microvascular obstruction persists in up to 60% of patients. Excimer laser coronary angioplasty (ELCA) vaporizes thrombus in situ and may reduce distal embolization, but the evidence base has not been systematically synthesized. This systematic review and meta-analysis (PROSPERO CRD420261422463) included comparative studies of adjunctive ELCA versus aspiration thrombectomy (Stratum A) or PCI alone (Stratum B) in acute coronary occlusion. Primary outcomes were final TIMI-3 flow and myocardial blush grade (MBG) 3; secondary outcomes were short-term mortality, MACCE, and slow-flow/no-reflow. A random-effects model with Hartung-Knapp-Sidik-Jonkman confidence intervals was applied to all outcomes. Certainty was assessed with GRADE. Ten studies (1 RCT, 9 observational) were included, from a total enrolled population exceeding 3,500. In Stratum A, no outcome reached significance: MBG-3 (OR 3.57, 95% CI 0.07-185.10), mortality (OR 0.31, 0.02-4.04), MACCE (OR 0.22, 0.04-1.26), TIMI-3 flow (OR 1.58, 0.67-3.75) and slow-flow/no-reflow (OR 0.78, 0.22-2.78). In Stratum B, using each study's propensity-matched data, no outcome differed significantly (TIMI-3 OR 0.88, 0.38-2.03; MBG-3 OR 1.06, 0.13-8.43; slow-flow/no-reflow OR 0.93, 0.29-3.02; mortality OR 0.44, 0.05-3.80). Composite endpoints were not pooled across incompatible follow-up horizons, and all outcomes were of very low certainty. Adjunctive ELCA-containing strategies during primary PCI were not associated with improved angiographic or short-term clinical outcomes against either comparator. Multicenter randomized trials are required before recommending clinical adoption. **Keywords:** Aspiration thrombectomy; Excimer laser coronary angioplasty; Myocardial infarction; PCI; STEMI; Unstable angina. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations: In accordance with the journal’s policy on Artificial Intelligence Generated Content (AIGC) and the COPE positi on statement, the authors declare the use of Gemini tool for the purpose of developing the graphical abstract. This tool was utilized to assist in the visual formation of the figure that summarizes the primary findings of this research. The authors have transparently described this use here and confirm that they are fully responsible for the accuracy of the information presented in the figure, for the correct referencing of supporting work, and for the final editorial decisions regarding the image. Gemini tool was not used as an author, nor was it involved in research design or data interpretation. Consent to participate: Not applicable. Clinical trial number: Not applicable (this research does not report the results of a clinical trial). Competing interests: All authors have no competing interests or financial ties to disclose. ## Similar articles * [ Comparison of the efficacy of excimer laser coronary angioplasty for ST-segment elevation myocardial infarction with onset-to-balloon time. ](https://pubmed.ncbi.nlm.nih.gov/37217741/) Kujiraoka H, Tsuchiyama T, Inagaki D, Yoshida K, Fukamizu S.Kujiraoka H, et al.Lasers Med Sci. 2023 May 23;38(1):126. doi: 10.1007/s10103-023-03789-z.Lasers Med Sci. 2023.PMID: 37217741 * [ Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial. ](https://pubmed.ncbi.nlm.nih.gov/27125948/) Sharma V, Jolly SS, Hamid T, Sharma D, Chiha J, Chan W, Fuchs F, Bui S, Gao P, Kassam S, Leung RC, Horák D, Romppanen HO, El-Omar M, Chowdhary S, Stanković G, Kedev S, Rokoss MJ, Sheth T, Džavík V, Overgaard CB.Sharma V, et al.Eur Heart J. 2016 Jun 21;37(24):1891-8. doi: 10.1093/eurheartj/ehw157. Epub 2016 Apr 28.Eur Heart J. 2016.PMID: 27125948Free PMC article.Clinical Trial. * [ Benefits of excimer laser coronary angioplasty over thrombus aspiration therapy for patients with acute coronary syndrome and thrombolysis in myocardial infarction flow grade 0. ](https://pubmed.ncbi.nlm.nih.gov/36542184/) Arai T, Tsuchiyama T, Inagaki D, Yoshida K, Fukamizu S.Arai T, et al.Lasers Med Sci. 2022 Dec 21;38(1):13. doi: 10.1007/s10103-022-03691-0.Lasers Med Sci. 2022.PMID: 36542184 * [ Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels. ](https://pubmed.ncbi.nlm.nih.gov/22185559/) Sobieraj DM, White CM, Kluger J, Tongbram V, Colby J, Chen WT, Makanji SS, Lee S, Ashaye A, Coleman CI.Sobieraj DM, et al.BMC Cardiovasc Disord. 2011 Dec 20;11:74. doi: 10.1186/1471-2261-11-74.BMC Cardiovasc Disord. 2011.PMID: 22185559Free PMC article. * [ Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty: an updated meta-analysis of randomized trials. ](https://pubmed.ncbi.nlm.nih.gov/23665372/) Kumbhani DJ, Bavry AA, Desai MY, Bangalore S, Bhatt DL.Kumbhani DJ, et al.J Am Coll Cardiol. 2013 Oct 15;62(16):1409-18. doi: 10.1016/j.jacc.2013.04.025. Epub 2013 May 9.J Am Coll Cardiol. 2013.PMID: 23665372 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42736488) ## References 1. 1. Inohara T, Kohsaka S, Spertus JA et al (2013) Comparative trends in percutaneous coronary intervention in Japan and the United States, 2013 to 2017. J Am Coll Cardiol 76(11):1328–1340. - [DOI](https://doi.org/10.1016/j.jacc.2020.07.037) 2. 1. McCartney PJ, Eteiba H, Maznyczka AM et al (2019) Effect of low-dose intracoronary alteplase during primary percutaneous coronary intervention on microvascular obstruction in patients with acute myocardial infarction: a randomized clinical trial. JAMA 321(1):56–68. - [DOI](https://doi.org/10.1001/jama.2018.19802) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30620371/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/6583564/) 3. 1. Cenko E, Badimon L, Vadalà G et al (2026) Pathophysiology, prevention, and management of coronary microvascular obstruction. Eur Heart J. - [DOI](https://doi.org/10.1093/eurheartj/ehag334) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/42185090/) 4. 1. Ndrepepa G, Kastrati A (2023) Coronary no-reflow after primary percutaneous coronary intervention—current knowledge on pathophysiology, diagnosis, clinical impact and therapy. J Clin Med 12(17):5592. - [DOI](https://doi.org/10.3390/jcm12175592) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/37685660/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10488607/) 5. 1. de Waha S, Patel MR, Granger CB et al (2017) Relationship between microvascular obstruction and adverse events following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: an individual patient data pooled analysis from seven randomized trials. Eur Heart J 38(47):3502–3510. - [DOI](https://doi.org/10.1093/eurheartj/ehx414) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29020248/) Show all 42 references ## Publication types * Meta-Analysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Meta-Analysis%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Meta-Analysis) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42736488/) * Systematic Review Actions *
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