TY - JOUR
T1 - Percutaneous excimer laser coronary angioplasty
T2 - Results in the first consecutive 3,000 patients
AU - Litvack, Frank
AU - Eigler, Neal
AU - Margolis, James
AU - Rothbaum, Donald
AU - Bresnahan, John F.
AU - Holmes, David
AU - Untereker, William
AU - Leon, Martin
AU - Kent, Kenneth
AU - Pichard, Augusto
AU - King, Spencer
AU - Ghazzal, Ziyad
AU - Cummins, Frank
AU - Krauthamer, Daniel
AU - Palacios, Igor
AU - Block, Peter
AU - Hartzler, Geoffrey O.
AU - O'Neill, William
AU - Cowley, Michael
AU - Roubin, Gary
AU - Klein, Lloyd W.
AU - Frankel, Phillip S.
AU - Adams, Curtis
AU - Goldenberg, Tsvi
AU - Laudenslager, James
AU - Grundfest, Warren S.
AU - Forrester, James S.
PY - 1994/2
Y1 - 1994/2
N2 - Objectives. We report the comprehensive results of the first consecutive 3,000 patients treated in an excimer laser coronary angioplasty registry. Background. Excimer laser coronary angioplasty involves the use of a pulsed, 308-nm ultraviolet laser transmitted by optical fibers to reduce coronary stenoses. Preliminary reports have described safety and efficacy profiles in small numbers of patients. Methods. Patients were enrolled in a prospective, nonrandomized manner. The catheters used were 1.3, 1.6, 2.0, 2.2 and 2.4 mm in diameter, at energy densities up to 70 mJ/mm2. Procedures were performed by standard angioplasty technique with conventional guide catheters. Results. Seventy-five percent of patients were male, 68% were in Canadian Cardiovascular Society functional class III or IV and the cohort included 3,592 lesions. Procedural success (final stenosis ≤50% without in-hospital Q wave myocardial infarction, coronary artery bypass surgery or death) was 90% and did not differ between the first 2,000 and the last 1,000 patients treated. There was no significant difference in success or complication rates with respect to lesion length, nor were there differences between selected complex and simple lesions. Complications included in-hospital bypass surgery (3.8%), Q wave myocardial infarction (2.1%) and death (0.5%). Coronary artery perforation occurred in 1.2% of patients (1% of lesions) but significantly decreased to 0.4% in the last 1,000 patients (0.3% of lesions). Angiographic dissection occurred in 13% of lesions, transient occlusion in 3.4% and sustained occlusion in 3.1%. Comprehensive lesion morphologic data collected in the latter portion of the study showed the procedure predominantly limited to American College of Cardiology-American Heart Association type B2 and C lesions, with no significant difference in short-term outcome between groups. Conclusions. Excimer laser angioplasty can be safely and effectively applied, even in a variety of complex lesions not well suited for percutaneous transluminal coronary angioplasty. These types may include aorto-ostial, long lesions, total occlusions crossable with a wire, diffuse disease and vein grafts. Most recent data show a trend for the selection of predominantly complex lesions and a reduction in the incidence of perforation. This procedure may broaden the therapeutic window for the interventional treatment of selected complex coronary artery disease.
AB - Objectives. We report the comprehensive results of the first consecutive 3,000 patients treated in an excimer laser coronary angioplasty registry. Background. Excimer laser coronary angioplasty involves the use of a pulsed, 308-nm ultraviolet laser transmitted by optical fibers to reduce coronary stenoses. Preliminary reports have described safety and efficacy profiles in small numbers of patients. Methods. Patients were enrolled in a prospective, nonrandomized manner. The catheters used were 1.3, 1.6, 2.0, 2.2 and 2.4 mm in diameter, at energy densities up to 70 mJ/mm2. Procedures were performed by standard angioplasty technique with conventional guide catheters. Results. Seventy-five percent of patients were male, 68% were in Canadian Cardiovascular Society functional class III or IV and the cohort included 3,592 lesions. Procedural success (final stenosis ≤50% without in-hospital Q wave myocardial infarction, coronary artery bypass surgery or death) was 90% and did not differ between the first 2,000 and the last 1,000 patients treated. There was no significant difference in success or complication rates with respect to lesion length, nor were there differences between selected complex and simple lesions. Complications included in-hospital bypass surgery (3.8%), Q wave myocardial infarction (2.1%) and death (0.5%). Coronary artery perforation occurred in 1.2% of patients (1% of lesions) but significantly decreased to 0.4% in the last 1,000 patients (0.3% of lesions). Angiographic dissection occurred in 13% of lesions, transient occlusion in 3.4% and sustained occlusion in 3.1%. Comprehensive lesion morphologic data collected in the latter portion of the study showed the procedure predominantly limited to American College of Cardiology-American Heart Association type B2 and C lesions, with no significant difference in short-term outcome between groups. Conclusions. Excimer laser angioplasty can be safely and effectively applied, even in a variety of complex lesions not well suited for percutaneous transluminal coronary angioplasty. These types may include aorto-ostial, long lesions, total occlusions crossable with a wire, diffuse disease and vein grafts. Most recent data show a trend for the selection of predominantly complex lesions and a reduction in the incidence of perforation. This procedure may broaden the therapeutic window for the interventional treatment of selected complex coronary artery disease.
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U2 - 10.1016/0735-1097(94)90414-6
DO - 10.1016/0735-1097(94)90414-6
M3 - Article
C2 - 8294681
AN - SCOPUS:0028064002
SN - 0735-1097
VL - 23
SP - 323
EP - 329
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 2
ER -