LASER-ASSISTED CORONARY ANGIOPLASTY IN PATIENTS WITH SEVERELY DEPRESSED LEFT-VENTRICULAR FUNCTION - QUANTITATIVE CORONARY ANGIOGRAPHY AND CLINICAL-RESULTS

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.