CORONARY INTERVENTION WITH THE EXCIMER-LASER - A CURRENT PERSPECTIVE

One variety of the excimer corollary laser system (Advanced interventi onal Systems) has been available for use in selected clinical centers from 1989 through 1995. This over-the-wire catheter-laser system uses a 308-nm laser and requires prepositioning of a 0.014'' to 0.018'' gui dewire across the target stenosis. Development of the coronary laser s ystem was stimulated by the limitations of conventional angioplasty, w hich have included abrupt reclosure, coronary dissection, restenosis, and chronic total occlusion. The excimer coronary laser angioplasty (E LCA) registry includes nearly 4,000 patients who have undergone attemp ted laser angioplasty. A success rate comparable to standard balloon a ngioplasty and an acceptably low complication rate were achieved in th is registry database. While laser angioplasty has been promoted for lo ng, diffuse lesions, total occlusions, lesions with substantial side b ranch involvement, and a possible therapy to reduce the incidence of r estenosis, the highly selected nature of patients enrolled in the regi stry prevents any definite conclusions regarding the utility of intrac oronary laser in these potential indications. Additionally, the advent of newer technologies, including rotablator and stenting, may further erode any potential advantages of coronary laser angioplasty. Randomi zed trials of newer interventional devices will be required to determi ne their true value and clinical utility.