Six-month outcome after excimer laser coronary angioplasty for diffuse in-stent restenosis in native coronary arteries

This study evaluated the intermediate-term follow-up after excimer laser coronary angioplasty (ELCA) and adjunctive percutaneous transluminal coronary angioplasty (PTCA) in patients with diffuse in-stent restenosis (lesion length >10 mm). Clinical and angiographic follow-up were performed at 6 mo...

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Bibliographic Details
Published in:The American journal of cardiology 2000-08, Vol.86 (4), p.390-394
Main Authors: Hamburger, Jaap N, Foley, David P, de Feyter, Pim J, Wardeh, Alexander J, Serruys, Patrick W
Format: Article
Language:English
Subjects:
Angina
Angiography
Angioplasty
Angioplasty, Balloon, Coronary
Angioplasty, Balloon, Laser-Assisted
Arteries
Biological and medical sciences
Cardiovascular disease
Catheters
Combined Modality Therapy
Coronary Angiography
Coronary artery
Coronary Disease - surgery
Coronary Disease - therapy
Coronary vessels
Creatinine - blood
Diseases of the cardiovascular system
Female
Follow-Up Studies
Heart attacks
Heart surgery
Hematoma
Humans
Implantation
Implants
Lasers
Male
Medical imaging
Medical sciences
Middle Aged
Occlusion
Patients
Postoperative Period
Radiation therapy
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Recurrence
Restenosis
Stenosis
Stents
Success
Surgical implants
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Summary:This study evaluated the intermediate-term follow-up after excimer laser coronary angioplasty (ELCA) and adjunctive percutaneous transluminal coronary angioplasty (PTCA) in patients with diffuse in-stent restenosis (lesion length >10 mm). Clinical and angiographic follow-up were performed at 6 months. Quantitative coronary angiography performed at 3 stages—during stent implantation, before and after ELCA + PTCA, and at follow-up—included measurements of the minimum lumen diameter (MLD) and percent diameter stenosis (DS). Sixteen consecutive patients were included. The (median + range) stent length was 36 mm (range 15 to 105), with a restenotic lesion length of 32 mm (range 10 to 90). After ELCA + PTCA, the MLD increased from 0.60 ± 0.41 to 2.28 ± 0.50 mm, whereas the DS decreased from 76 ± 16% to 22 ± 8%. Despite adjunctive high-pressure PTCA, the MLD after ELCA + PTCA remained smaller than the MLD after initial stent implantation, (2.28 ± 0.50 mm vs 2.67 ± 0.32 mm, p = 0.014). Adverse events included ELCA-related acute coronary occlusion in 4 patients and a per-procedural intracerebral hematoma in 1. At 6 months, there was recurrence of angina in all patients. Angiographic follow-up was completed in 13 patients (87%), showing a reocclusion in 6 (46%), a >50% DS in 6 (MLD 1.03 ± 0.87 mm, DS 68 ± 24%), and a distal de novo lesion in 1. Despite satisfactory acute angiographic results, the recurrence of significant restenosis in all patients suggests that ELCA + PTCA is not a suitable stand-alone therapy for diffuse in-stent restenosis of long stented segments.
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(00)00952-8