IMMEDIATE AND LATE OUTCOME OF EXCIMER-LASER AND BALLOON CORONARY ANGIOPLASTY - A QUANTITATIVE ANGIOGRAPHIC COMPARISON BASED ON MATCHED LESIONS

Objectives. This study sought to compare acute lumen changes and late lumen narrowing during and after excimer laser-assisted balloon angiop lasty, measured by quantitative coronary angiography, with the immedia te and long-term outcome of balloon angioplasty alone. Background. Alt hough excimer laser coronary angioplasty is used as an adjunct or alte rnative to balloon angioplasty, limited comparative data exist regardi ng the immediate and long-term efficacy of excimer laser-assisted ball oon angioplasty versus balloon angioplasty alone. Methods. A series of 53 lesions in 47 consecutive patients successfully treated with excim er laser-assisted balloon angio plasty were individually matched after completion of 6 month follow-up angiography with 53 successfully trea ted balloon angioplasty lesions according to vessel location, preproce dural minimal lumen diameter and reference diameter. Immediate and lon gterm angiographic results were assessed by an automated lumen contour detection algorithm. Results. Before intervention in the laser and ba lloon angioplasty groups, respectively, minimal lumen diameter (mean /- SD) was 0.73 +/- 0.47 and 0.74 +/- 0.46 mm, and reference diameter was 2.71 +/- 0.42 and 2.72 +/- 0.41 mm. Laser angioplasty was followed by adjunctive balloon dilation in 50 lesions. Mean balloon diameter a t maximal inflation was similar in both treatment groups (2.61 +/- 0.3 2 and 2.65 +/- 0.38 mm, respectively), resulting in similar minimal lu men diameters after intervention of 1.77 +/- 0.41 and 1.78 +/- 0.34 mm , respectively. At follow-up angiography, minimal lumen diameter after excimer laser-assisted balloon angioplasty was 1.17 +/- 0.63 mm, and that after balloon angioplasty alone was 1.36 +/- 0.67 mm (p = 0.02). The angiographic restenosis rates at follow-up using the 50% diameter stenosis cutoff criterion were 57% and 34%, respectively (p = 0.02). C onclusions. Quantitative angiographic analysis of a matched group of 1 06 successfully treated coronary lesions showed a similar immediate ou tcome but reduced long-term efficacy of excimer laser-assisted balloon angioplasty compared,vith that after balloon angioplasty alone.