Clinical experience of excimer laser coronary angioplasty

Abstract

Excimer laser coronary angioplasty (ELCA) was performed on 36 lesions in 34 patients. The patients consisted of 28 males and 6 females. The mean age was 61±11 years. The lesion was located in the protected left main (1), the left anterior descending artery (28), the left circumflex artery (1), the right coronary artery (3) and saphenous vein bypass graft (3). Nine lesions (25%) were prior angioplasty restenotic lesions. Advanced Interventional Systems Dymer 200+laser system emitting energy at a wavelength of 308nm with a pulse duration of 200 nsec was used. The laser was operated at 20 Hz. Laser energy was delivered through multifiber catheters 1.3, 1.6, or 2.0mm in diameter. Energy fluences at the catheter tip was set at 45 to 60mJ/mm2 per pulse. Laser catheter was advanced into the coronary artery by the over-the-wire technique. Acute laser success was defined as a more than 20% reduction in percent stenosis by laser alone. Procedural success was defined as a final percent stenosis of 50% or less without major complications (death, myocardial infarction and emergency coronary bypass surgery). The reference diameter of treated vessel was 2.7±0.6mm. Seven lesions (19%) were longer than 10mm in length. Seventeen lesions (47%) were calcified lesions. The mean laser operating time was 16±19 seconds. In 19 lesions the laser operating time was less than 10 seconds. The percent stenosis improved from a baseline of 81±10% to 51±20% after ELCA. Acute laser success was achieved in 26 lesions (72%). Adjunctive balloon angioplasty was performed on 25 lesions (69%) in an attempt to obtain an optimal results. The final percent stenosis was 31±13%. The final percent stenosis was less than 50% in 34 lesions (94%) and procedure success was achieved in 33 lesions (92%). Complications included major dissection (8%), transient closure (11%), and side branch occlusion (6%). In one patient transient leakage of contrast media was observed. In this patient emergency coronary bypass surgery was performed to prevent rebleeding. There were no deaths or myocardial infarctions. Our study suggested that ELCA was effective technique especially for lesions not suitable for conventional balloon angioplasty.