Improved results of coronary excimer laser angioplasty by the use of advanced transmission devices
Excimer laser angioplasty is an alternative method for the treatment of obstructive coronary lesions. Initial clinical results demonstrated the safety and feasibility of the procedure. However, efficacy was limited by low catheter flexibility and unreliable energy transmission. Advanced transmission devices were used in 80 interventions in 79 patients. The catheter diameter is 1.3, 1.5 or 1.8 mm, the catheters consist of 20, 30 or 35 quartz fibres (100 μm) respectively. The mean energy density was 55 ±18 mJ mm−2, mean loss of energy transmission was 20%. The pulse width was 60 ns and 115 ns in 40 interventions each. The target vessel was the LAD in 53, the LCX in 6 and the RCA in 21 interventions.
Failure of laser angioplasty occurred in 10 patients due to failed guidewire placement (N=6), failed catheter placement (N=3) or impossibility to cross the lesion with the catheter (N=1). Stand-alone laser angioplasty was performed in 43/70 procedures. Additional balloon angioplasty was necessary due to an unsatisfactory result (N=10) or due to complications (N=17) in 27 patients. Vessel occlusion occurred in 18 patients (25%) and could be successfully resolved by balloon dilatation (N=16) or additional laser angioplasty (N=1) in 17 patients. Two early occlusions were found at the 24-h control angiography. The incidence of myocardial infarction and in-hospital death (N=1) was 1.4%.
Conclusion: The use of an advanced energy delivery system with trusted energy transmission and higher energy density increased the primary success rate of stand-alone excimer laser angioplasty. However, further improvement of catheter flexibility and reduction of dead space at the catheter tip is necessary to optimize ablation efficacy.
Laser angioplasty Coronary artery disease PTCA
Forrester JS. Laser angioplasty.Circulation
Grundfest WS, Litvack F, Forrester JR et al. Laser ablation of human atherosclerotic plaque without adjacent tissue injury.J Am Coll Cardiol
Isner JM, Donaldson RF, Deckelbaum LI et al. The excimer laser: gross, light microscopic and ultrastructural analysis of potential disadvantages for use in laser therapy of cardiovascular disease.J Am Coll Cardiol
Waller BF. Pathology of new interventions used in the treatment of coronary heart disease.Curr Probl Cardiol
Haase KK, Wehrmann M, Duda S, Karsch KR. Experimentelle intrakoronare Excimer-Laserangioplastie.Z Kardiol
Karsch KR, Haase KK, Voelker W et al. 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
Baumbach A, Haase KK, Voelker W et al. Effects of intracoronary nitroglycerin on lumen diameter during early follow-up angiography after coronary excimer laser atherectomy.Eur Heart J
Campeau L. Grading of angina pectoris (letter).Circulation
Kent KM, Bentivoglio LG, Block PC et al. Percutaneous transluminal coronary angioplasty: report from the registry of the National Heart, Lung, and Blood Institute.Am J Cardiol
Ellis SG, Vandormael MG, Cowley MJ et al, and the Multivessel Angioplasty Prognosis Study Group. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease.Circulation
Kahn JK, Hartzler GO. Frequency and causes of failure with contemporary coronary angioplasty and implications for new technologies.Am J Cardiol
Baumbach A, Haase KK, Voelker W, Karsch KR. Vasospasm following coronary excimer laser angioplasty (Abstract).Eur Heart J
Gal D, Steg PG, Rongione AJ et al. Vascular spasm complicates continuous wave but not pulsed laser irradiation.Am Heart J
Steg PG, Rongione AJ, Gal D et al. Pulsed ultraviolet laser irradiation produces endothelium-independent relaxation of vascular smooth muscle.Circulation