LASER THROMBOLYSIS IN ACUTE MYOCARDIAL-INFARCTION - RESULTS OF A CLINICAL FEASIBILITY STUDY

Laser thrombolysis is a new, experimental, catheter based intervention aimed at selectivity removing intracoronary thrombus. This first clin ical study was performed to assess the feasibility and safety of laser thrombolysis, as well as its potential therapeutic place in acute myo cardial infarction. Eighteen patients with acute myocardial infarction , who were either noncandidates for, or failures on, intravenous fibri nolytic therapy were included for treatment with laser thrombolysis fo llowed by balloon angioplasty. As a result of catheter and technical f ailures, the laser was actually fired in only 12 patients. Improvement in TIMI flow from grade 0-1 to grade 2-3 was observed in 10 of these 12 patients after laser application. The overall results of 18 patient s were: increase in TIMI grade flow from 0.33 +/- 0.49 after wire pass age to 1.28 +/- 1.23 (P = 0.0051) after attempted laser application, a nd to 2.67 +/- 0.97 after PTCA (P = 0.0004). Two patients with previou s infarctions died from left ventricular failure despite successful la ser thrombolysis. One patient died during emergency bypass surgery aft er a failed recanalization attempt. Perforation or laser related disse ction did not occur. The concept of selective laser thrombus ablation seems to be safe and feasible, but substantial improvements of the las er delivery catheters are needed. Laser thrombolysis is not an effecti ve stand-alone therapy in acute myocardial infarction, but other possi ble applications warrant further research and development efforts for this potentially useful interventional tool.