Summary
Of 124 consecutive patients undergoing elective excimer laser coronary angioplasty, 33 (26%) had periprocedural occlusion following excimer laser irradiation. Successful management (reopened vessel, no death, no myocardial infarction, no emergency bypass surgery) including repeat lasing, subsequent percutaneous transluminal coronary angioplasty, use of intracoronary nitroglycerin or streptokinase was achieved in 32 of the patients with acute occlusion following excimer laser coronary angioplasty. In one patient a nonfatal anterior myocardial infarction occurred. A late event occurred in two patients despite patency at the control angiography 24 h later. Multiple logistic regression modeling was used to examine the relationship between various characteristics and the risk of acute vessel closure. The preprocedural and procedural variables analyzed included progressive spasm prior to occlusion and lesion morphology after intervention (angiography complications after percutaneous transluminal coronary angioplasty were prospectively divided into class 0, no complication, and classes 1–3, according to purely descriptive morphological characteristics). These showed a multivariate correlation with acute occlusion during excimer laser coronary angioplasty. These results suggest that acute vessel closure during stand-alone excimer laser coronary angioplasty is a benign but unpredictable event.
Similar content being viewed by others
Abbreviations
- ELCA:
-
excimer laser coronary angioplasty
References
Baumbach A, Haase KK, Voelker W, Mauser M, Karsch KR (1991) Effects of intracoronary nitroglycerin on the lumen diameter during early follow-up angiography after coronary excimer laser atherectomy. Eur Heart J 12:726–731
Braunwald E (1989) Unstable angina. A classification. Circulation 80:410–414
Brown BG, Belson EL, Dodge HT (1982) Arteriographic assessment of coronary atherosclerosis. Review of current methods, their limitations, and clinical applications. Arteriosclerosis 2:2–15
Cook SL, Eigler NL, Shefer A, Goldenberg T, Forrester JS, Litvack F (1991) Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty. Circulation 84:632–643
De Feyter PJ, van den Brand M, Jaarman GJ, van Domburg R, Serruys PW, Suryapranata H (1991) Acute coronary artery occlusions during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management and follow-up. Circulation 83:927–936
Cowley MJ, Dorros G, Kelsey SF, Van Raden M, Detre KM (1984) Acute coronary artery events associated with percutaneous transluminal coronary angioplasty. Am J Cardiol 53:12C–16C
De Feyter PJ, Serruys PW, van den Brand M (1985) Emergency coronary angioplasty in refractory unstable angina. N Engl J Med 313:342–347
Ellis SG, Roubin GS, King SB III, Douglas JS, Weintraub WS, Thomas RG, Cox WR (1988) Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 77:372–379
Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, Bulle TM (1990) Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Circulation 82:1193–1202
Gal D, Steg PG, Rongione AJ, De Jesus ST, Clarke RH, Isner JM (1989) Vascular spasm complicates continuous wave but not pulsed laser irradiation. Am Heart J 118:934–941
Goldbaum TS, Disciascio G, Cowley MJ, Vetrovek GW (1987) Acute occlusion following successful percutaneous transluminal coronary angioplasty (letter). Am J Cardiol 60:1217
Harrell FE, Lee KL (1985) The practical value of logistic regression. Proceedings of the Tenth Annual SAS Users Group International Conference, Cary, North Carolina. SAS Institute, Cary NC, pp 1031–1036
Hoak JC (1989) The endothelium, platelets, and coronary vasospasm. Adv Intern Med 34:353–376
Holmes DR Jr, Holubkov R, Vliestra RE, Kelsey SF, Reeder GS, Dorros G, Williams DO, Cowley MJ, Faxon DP, Kent KM, Bentivoglio LG, Detre K, Co-investigators of the NHLBI PTCA Registry (1988) Comparison of complications during percutaneous transluminal coronary angioplasty from 1977 to 1981 and from 1985 to 1986: the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. J Am Coll Cardiol 12:1149–1155
Holmes DR Jr, Vliestra RE, Schmith HC, Veetrovec GW, Kent KM, Cowley MJ, Faxon DP, Gruentzig AR, Kelsey SF, Detre KM, van Raden JM, Mock MB (1984) Restenosis after percutaneous transluminal coronary angioplasty (PTCA): a report from the PTCA Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol 53:77C–81C
Karsch KR, Haase KK, Voelker W, Baumbach A, Mauser M, Seipel L (1990) Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up. Circulation 81:1849–1859
Levin DC, Fallon JT (1982) Significance of the angiographic morphology of localized coronary stenosis: histopathologic correlations. Circulation 66:316–320
Litvack F, Eigler N, Margolis JR, Grundfest W, Rothbaum D, Linnemeier T, Hestrin LB, Tsoi D, Cook SL, Krauthairier D et al. (1990) Percutaneous excimer laser coronary angioplasty. Am J Cardiol 66:1027–1032
Maseri A, Davies G, Hackett D, Kaski JC (1990) Coronary artery spasm and vasoconstriction. The case of a distinction. Circulation 81:1983–1991
McMahon MM, Brown BG, Cukingman R, Rolett E, Bolson E, Frimer M, Dodge H (1979) Quantitative coronary angiography: measurements of the “critical” stenosis in patients with unstable angina and single-vessel disease without collaterals. Circulation 60:106–113
Nobuyoshi M, Kimura T, Nosaka H, Mioka S, Ueno K, Yokoi H, Hamasaki N, Horiuchi H, Ohishi H (1988) Restenosis after percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. J Am Coll Cardiol 616–623
Preisack MB, Athanasiadis A, Voelker W, Karsch KR (1993) Reability of quantitative coronary angiography of the target lesion immediately and one day after coronary balloon and excimer laser angioplasty. J Am Coll Cardiol 21:876–884
Preisack MB, Voelker W, Haase KK, Karsch KR (1992) Formation of vessel aneurysm after stand alone coronary angioplasty. Cath Cardiovasc Diagn 27:122–124
Sachs L (1992) Angewandte Statistik, 7th edn. Springer, Berlin Heidelberg New York
Sanborn TA, Bittle JA, Hershman RA, Siegel RM (1991) Percutaneous coronary excimer laser-assisted angioplasty: initial multicenter experience in 141 patients. J Am Coll Cardiol 17:169B–173B
Sanborn TA, Torre SR, Sharma SK, Hershman RA, Cohen M, Sherman W, Ambrose JA (1991) Percutaneous coronary excimer-laser-assisted balloon angioplasty: initial clinical and quantitative results in 50 patients. J Am Coll Cardiol 17:94–99
Simpfendorfer C, Belardi J, Bellamy G, Galan K, Franco I, Hollman J (1987) Frequency, management and follow-up of patients with acute coronary occlusions after percutaneous transluminal coronary angioplasty. Am J Cardiol 59:267–269
Sinclair IN, McCabe CH, Sipperly ME, Baim DS (1988) Predictors, therapeutic options and long-term outcome of abrupt reclosure. Am J Cardiol 61:61G–66G
Steffenino G, Meier B, Finci L, Velebeit V, von Segesser L, Faidutti B, Rutishauser W (1988) Acute complication of elective coronary angioplasty: a review of 500 consecutive procedures. Br Heart J 59:151–158
Thrombolysis in Myocardial Infarction Study Group (1985) The thrombolysis in myocardial infarction trial. N Engl J Med 81:505–511
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Preisack, M.B., Athanasiadis, A., Liewald, C. et al. Acute vessel closure following excimer laser coronary angioplasty: can we predict it?. Clin Investig 71, 978–984 (1993). https://doi.org/10.1007/BF00180027
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00180027