Result of a pilot study on percutaneous coronary excimer laser ablation in patients with coronary artery disease

Summary

The clinical results of conventional percutaneous transluminal coronary angioplasty are limited by a restenosis rate that approaches 40%. Laser ablation of atherosclerotic plaque using an excimer laser and a new catheter device for energy transmission has been suggest to be one alternative approach for treatment of obstructive lesions. This pilot study was designed as a first clinical trial in patients with coronary artery disease to determine the feasibility, efficacy and safety of this alternative method. In 55 of 60 patients which were included in this trial excimer laser ablation could be performed. In 23 patients the results of laser treatment was sufficient and no additional intervention necessary. In 32 patients, however, subsequent balloon angioplasty was performed. In eleven of these 32 patients additional PTCA was necessary due to early vessel closure immediately after laser ablation and in 21 patients because the qualitative result was not sufficient in reduction of the initial degree of stenosis of more than 50%. Three serious complications were encountered in this series. One patient died after early vessel closure 2 hours after intervention and in 2 patients a Q-wave infarction occurred after persistent vessel closure following laser ablation. Vessel perforation or extravasation of dye, however, did not occur.

The results of this pilot study suggest that coronary excimer laser angioplasty is feasible. The acute success rate of this method, however, is reduced in comparison to conventional PTCA. Thus, improvement of the catheter system is mandantory before further clinical studies are performed. Furthermore- the incidence of restenosis after laser ablation has to be determined and compared to PTCA in further randomized studies.