Results of the LASER-EXPAND trial suggest that combining laser atherectomy with high-pressure balloon dilatation significantly improves stent expansion compared to high-pressure dilatation alone. Further findings of this trial, presented during a Late-Breaking Clinical Science session at Cardiovascular Research Technologies (CRT) 2025 and involved patients with resistant underexpanded stents, also demonstrated an absence of any major laser-derived complications. “Our randomized trial showed a significant minimum lumen area (MLA) gain in the laser + high-pressure dilatation group compared to dilatation alone (0.46±0.21 vs 0.24±0.21, p=0.037),” said Neus Bellera, MD, of theHospital Universitari Vall d´Hebron in Barcelona, Spain. “The change in percentage stent expansion was 44±24 vs 23±28 respectively (p=0.051),” she added. Minimum lumen area increases The laser benefit was also supported by similar increases in the minimum lumen area (MLA) observed after laser as a “rescue” therapy. An in-stent MLA < 4.5% is accepted as an independent predictor of adverse events at follow-up. Typically, high pressure noncompliant balloon inflation remains the first-line treatment of underexpanded stents. Aggressive dilatation with super high-pressure balloons is an effective approach for the remaining resistant cases. Over the last decade, laser atherectomy (ELCA) has been used as adjunctive therapy to treat stent underexpansion with beneficial effects shown in resistant cases. However, the net profit on MLA attributable to laser therapy has not been analyzed in a randomized study. LASER-EXPAND trial The LASER-EXPAND trial, which enrolled 34 patients, also evaluated the safety profile of the combined therapy. The overall complication rate was 6.6%, with no significant differences between the two treatment groups. Commenting on the trial’s limitations, Dr. Bellera highlighted the trial’s small sample size, and intravascular imaging data that were missing in seven cases. “There was no systematic measurement of cardiac biomarkers post-procedure, so the incidence of periprocedural myocardial infarction (MI) could not be accurately ruled out,” she said. “Long-term clinical outcomes were not assessed, warranting further research.” Research methods The LASER-EXPAND trial, a prospective, multicenter, open-label, randomized study, enrolled 34 patients, who were eligible for inclusion if they were 18 years old or older. Patients were randomized 1:1 to either the laser + high-pressure dilatation group (n=16) or the high-pressure dilatation alone group (n=14). The primary endpoint was defined as the acute gain in MLA after percutaneous coronary intervention (PCI), as assessed by intravascular ultrasound (IVUS). Image Credit: Bailey G. Salimes Image Caption: Neus Bellera, MD, presents during a Late-Breaking Clinical Science session on Monday at Cardiovascular Research Technologies (CRT) 2025.