THE CHANGING PROFILE OF PATIENT SELECTION, PROCEDURAL TECHNIQUES, ANDOUTCOMES IN EXCIMER-LASER CORONARY ANGIOPLASTY

During the course of development development of excimer excimer laser angioplasty, several changes in patient selection and technique have o ccurred. It is uncertain, however, whether these changes have been ass ociated with improved procedural outcome. In this study, multivariable regression methods were used to identify the factors responsible for clinical success, major complications, and vessel perforation in 2,041 consecutive patients treated with excimer laser coronary angioplasty. The overall rates of clinical success were 89%, major complications 7 .5%, and vessel perforation 2.1%. Clinical success was 86% in patients treated with prototype catheters, 89% with flexible catheters, 92% wi th extremely flexible catheters, and 95% in patients treated with dire ctional eccentric catheters (P < 0.001). By multivariable analysis, cl inical success increased with each subsequent catheter design (odds ra tio [OR] = 1.4 per iteration [95% confidence interval 1.2, 1.6]), and with improved lesion selection. Major complications were reduced when operator had performed more than 25 cases (rate = 6.5%, OR = 0.7 [0.5, 0.9]), and the incidence of vessel perforation was decreased when the size of the target vessel was > 1.0 mm larger than the diameter of th e laser catheter (rate = 1.1%, OR 0.3 [0.2, 0.5]). In conclusion, duri ng the course of clinical investigation with excimer laser angioplasty , procedural outcome has improved. These results emphasize the importa nce of careful patient selection and procedural technique to enhance t he success of excimer laser angioplasty.