HOLMIUM LASER-ASSISTED CORONARY ANGIOPLASTY IN ACUTE ISCHEMIC SYNDROMES

Background and hypothesis: Initial studies have shown holmium laser to be effective in ablation of coronary atheroma, and small studies sugg est that it may be helpful in ablation of thrombotic stenoses. Therefo re, holmium laser-assisted coronary angioplasty was studied in 85 cons ecutive patients with acute ischemia syndromes. Methods: Indications f or therapy were acute myocardial infarction (MI) in 7 patients (8%), p ost-MI ischemic in 32 patients (38%), and crescendo angina pectoris in 46 patients (54%). Coronary morphology characteristics by multivessel angioplasty prognosis group criteria were Type A in 9 (10%), Type B1 in 15 (18%), Type B2 in 44 (52%), Type C in 17 patients (20%). Results : Angiographic evidence of thrombus was seen in 37 (44%) of patients. The laser successfully crossed the total length of the coronary narrow ing in 76 patients (89%). Procedure/clinical success was 92% for the t otal study population, 100% for patients with acute MI, 94% for post-M I ischemia patients, and 89% for patients with crescendo angina. Lesio ns with and without thrombus had identical procedure success rates. Ma jor complication rate was 3.5%, (deaths 0%, Q-wave MI 0%, and emergent bypass surgery 3.5%). Six-month angiographic restenosis rate (>50% st enosis) was 45%. Conclusion: Holmium laser-assisted balloon angioplast y appears promising in the treatment of acute ischemic syndromes and t hrombotic coronary lesions.