Circulation, Vol 86, 71-80, Copyright © 1992 by American Heart Association
JA Bittl and TA Sanborn
BACKGROUND. Excimer laser coronary angioplasty has been reported to be a
promising treatment for complex coronary artery disease. The purpose of
this study was to define the predictors of acute success and restenosis
after this experimental intervention. METHODS AND RESULTS. A cohort of 200
consecutive patients had a minimum of 6 months of follow- up evaluation
after treatment of 215 coronary stenoses that were carefully selected for
excimer laser coronary angioplasty. At the time of the initial procedure,
the laser catheter alone produced a residual stenosis of less than or equal
to 50% at 119 of 215 lesions (55.4%). For complete dilatation, 87.9% of the
lesions required adjunctive balloon angioplasty. Clinical success was
achieved in 183 of the 200 patients (91.5%), as indicated by a reduction by
at least 20% of the narrowing of the vessel diameter, less than or equal to
50% residual stenosis, and no in-hospital complication. Complications
included abrupt closure (5.0%), myocardial infarction (3.5%), bypass
surgery (3.0%), perforation (2.0%), and death (0.0%). Logistic regression
analysis showed that lesions at vessel bifurcations (success rate, 66%;
adjusted odds ratio [OR] = 0.16; p = 0.002) or in tortuous vessels (success
rate, 82%; OR = 0.48; p = 0.004) were associated with decreased clinical
success. However, acceptable success rates were achieved in patients with
lesions in saphenous vein grafts more than 3 years old (success rate, 94%;
OR = 1.40; p = 0.75), in ostial lesions (success rate, 100%; OR = 3.36; p =
0.43), and in lesions longer than 10 mm (success rate, 93.5%; OR = 1.50; p
= 0.39). Clinical follow-up was available in 197 of the 200 patients
(98.5%) a mean of 5.9 +/- 1.9 months after angioplasty, at which time 31.0%
of patients had developed symptoms or evidence of ischemia. No patient died
during the study. Follow-up angiography was obtained in 83.1% of eligible
patients after a mean [+/- SD] of 5.2 +/- 2.0 months. Angiographic
restenosis, defined by greater than 50% stenosis, appeared at 78 of 164
lesions (47.6%). By logistic regression analysis, only lesions in saphenous
vein grafts were associated with a decreased rate of restenosis (restenosis
rate, 20%; OR = 0.18; p = 0.01). CONCLUSIONS. This analysis, which defines
the profile of risk for excimer laser angioplasty, provides a sound basis
for rigorous comparison of adjunctive excimer laser with balloon
angioplasty for ostial narrowings, long lesions, and saphenous vein graft
stenoses.
ARTICLES
Excimer laser-facilitated coronary angioplasty. Relative risk analysis of acute and follow-up results in 200 patients
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
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