Li. Deckelbaum et al., EFFECT OF INTRACORONARY SALINE INFUSION ON DISSECTION DURING EXCIMER-LASER CORONARY ANGIOPLASTY - A RANDOMIZED TRIAL, Journal of the American College of Cardiology, 26(5), 1995, pp. 1264-1269
Objectives. We sought to evaluate whether intracoronary saline infusio
n during excimer laser coronary angioplasty decreases the incidence of
significant laser-induced coronary artery dissections. Background. De
spite procedural success rates > 90%, coronary artery dissections occu
r in 17% to 27% of excimer laser coronary angioplasty procedures. Exci
mer laser irradiation of blood results in vapor bubble formation and a
coustomechanical trauma to the vessel wall. Saline infusion into a cor
onary artery may minimize blood irradiation and consequent arterial wa
ll damage. Methods. In this prospective, randomized, controlled study,
consecutive patients undergoing excimer laser coronary angioplasty we
re randomly assigned to conventional laser irradiation in a blood medi
um or to laser irradiation with blood displacement by intracoronary sa
line infusion. In the patients randomized to intracoronary saline infu
sion, prewarmed normal saline was injected through the coronary artery
guide catheter at a rate of 1 to 2 ml/s using a power injector, The i
ncidence and severity of dissection after excimer laser ablation were
evaluated in a core laboratory by angiographers with no knowledge of t
reatment assignment, The severity of coronary artery dissection was ra
ted on an ordinal scale of 1 to 5. Dissections of grade 2 or higher we
re considered significant. Results. The mean (+/- SE) dissection grade
after laser angioplasty in patients treated,vith intracoronary saline
infusion was 0.43 +/- 0.13 compared with 0.91 +/- 0.26 in patients un
dergoing laser angioplasty in a blood medium. The incidence of signifi
cant dissection was 7% in saline-treated patients compared with 24% in
conventionally treated patients (p < 0.05). No significant complicati
ons were associated with saline infusion. Conclusions. Intracoronary s
aline infusion should be incorporated into all excimer laser coronary
angioplasty procedures.