LASER-ASSISTED CORONARY ANGIOPLASTY IN PATIENTS WITH SEVERELY DEPRESSED LEFT-VENTRICULAR FUNCTION - QUANTITATIVE CORONARY ANGIOGRAPHY AND CLINICAL-RESULTS
O. Topaz et al., LASER-ASSISTED CORONARY ANGIOPLASTY IN PATIENTS WITH SEVERELY DEPRESSED LEFT-VENTRICULAR FUNCTION - QUANTITATIVE CORONARY ANGIOGRAPHY AND CLINICAL-RESULTS, Journal of interventional cardiology, 8(6), 1995, pp. 661-669
Laser-assisted coronary angioplasty can be successfully applied to les
ions nor ideal for balloon angioplasty. Patients with severely impaire
d left ventricular (LV) function and complex coronary artery stenoses
who call for percutaneous revascularization are considered a high risk
group for balloon angioplasty. In order to determine the feasibility,
safety, and acute clinical outcome of a solid state, pulsed wave, mid
-infrared (2.1 micron) laser facilitated angioplasty in these patients
, data from 112 patients with 129 lesions were analyzed. Patients were
identified according to angiographic LV function; group I included 22
patients with left ventricular ejection fraction (LVEF) less than or
equal to 40% (mean = 25% +/- 10%) and group II included 90 patients wi
th LVEF greater than or equal to 40% (mean = 58% +/- 8%). No differenc
e in age, gender, diabetes, hypertension, tobacco use, history of prev
ious coronary artery bypass surgery (CABGS) or percutaneous translumin
al coronary angioplasty was registered between the two groups. Multive
ssel disease, previous myocardial infarction (MI), and severe angina w
ere more prevalent among group I patients (P = 0.03). No difference wa
s found in lesion location, complexity, length, or calcification betwe
en the two groups; although group I had more eccentric lesions. Both g
roups were treated with the same laser energy level followed by adjunc
tive balloon angioplasty. One hundred percent procedural success was o
btained in group I versus 93% in group II (P = NS). By Q.C.A. (indepen
dent core lab), minimal luminal diameter increased in group I from 0.9
+/- 0.5 mm preprocedure to 2.0 +/- 0.5, as compared to 0.8 +/- 0.5 mm
to 1.9 +/- 0.5 mm (P = NS) in group II. Stenosis severity improved fr
om 69% +/- 16% preprocedure to 37% +/- 13% postprocedure in group I, a
s compared to improvement from 78% +/- 16% to 37% +/- 12.7% in group I
I (P = NS). Overall complication rate was remarkably low, with no deat
h ol perforation in either group; emergency CABGS 0% in group I and 1.
1% in group II; dissections 4.5% in group I and 8.8% in group II. Ther
e was no significant difference in complication rate between the two g
roups. The results of this study suggest that holmium: YAG laser facil
itated coronary angioplasty can be safely performed in patients with s
evere LV dysfunction, achieving a remarkably high procedural success a
nd low complication rate.