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Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease

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Abstract

Excimer laser has been successfully applied to complex atherosclerotic plaques in acute coronary syndromes; however, its role in debulking in left main coronary artery disease has not been fully explored. Details of a series of 20 patients who underwent excimer laser revascularization of a spectrum of left main coronary artery lesions are presented. Twenty symptomatic patients who received excimer laser debulking were examined for procedural outcome and follow up results. The left main coronary artery was characterized as protected, semi-protected, poorly protected, or unprotected, depending on the presence or absence of patent bypass grafts to the left anterior descending (LAD) and circumflex (CX) arteries. A fully protected left main coronary artery (LMCA) was present in only 20% of the patients. The target lesions included 11(55%) distal LMCA stenoses, six (30%) ostial stenoses, and one (5%) mid-portion lesions. Two (10%) patients had in-stent re-stenosis of the entire length of the LMCA. Small (0.7 mm–1.4 mm) excimer laser catheters were mostly used. A relatively high number of laser energy pulses (1,334 ± 643) were required to achieve adequate debulking. Successful LMCA intervention was performed in 19 (95%) patients, while in-hospital complications occurred in only one (5%) patient. Subacute/late stent thrombosis developed 3 months after the procedure in one patient, and two patients died from non-cardiac causes during follow-up. Lesions in LMCAs can be revascularized in selected patients by laser debulking and adjunct stenting. Inadequate protection by bypass grafts and decreased left ventricular function do not contradict utilization of excimer laser. Small laser catheters and high energy levels are required during laser debulking of stenoses of left main coronary arteries.

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Authors and Affiliations

  1. Interventional Cardiovascular Laboratories, Division of Cardiology, McGuire Veterans Affairs Medical Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    On Topaz, Pritam R. Polkampally, Pramod K. Mohanty, Maged Rizk, Julie Bangs & Nelson L. Bernardo

  2. Interventional Cardiology, McGuire Veterans Affairs Medical Center, Virginia Commonwealth University, 1201 Broad Rock Blvd, Richmond, VA, 23249, USA

    On Topaz

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  1. On Topaz
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  2. Pritam R. Polkampally
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Correspondence to On Topaz.

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Topaz, O., Polkampally, P.R., Mohanty, P.K. et al. Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease. Lasers Med Sci 24, 955–960 (2009). https://doi.org/10.1007/s10103-009-0650-y

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  • DOI: https://doi.org/10.1007/s10103-009-0650-y

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