EFFECT OF INTRACORONARY SALINE INFUSION ON DISSECTION DURING EXCIMER-LASER CORONARY ANGIOPLASTY - A RANDOMIZED TRIAL

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.