EXCIMER-LASER CORONARY ANGIOPLASTY OF AORTO-OSTIAL STENOSES - RESULTSOF THE EXCIMER-LASER CORONARY ANGIOPLASTY (ELCA) REGISTRY IN THE 1ST 200 PATIENTS

Background. Percutaneous transluminal coronary angioplasty (PTCA) of a orto-ostial stenosis has been associated with a lower rate of acute su ccess, a high risk of vessel closure, and late restenosis. The purpose of this report is to document a prospective multicenter trial of exci mer laser coronary angioplasty (ELCA) of aorto-ostial stenosis involvi ng the coronary arteries and saphenous vein grafts. Methods and Result s. Between December 1989 and May 1992, 206 aorto-ostial ELCA procedure s were performed on 209 stenoses in 200 patients. Canadian Cardiovascu lar Society class III or IV angina was present in 76%. The distributio n of stenosis locations was left main coronary (LM) in 26 (12%), right coronary (RCA) in 124 (59%), and vein grafts (VG) in 59 (28%). Adjunc tive PTCA was performed in 72%. Procedure success defined as less than -or-equal-to 50% diameter stenosis without major complications was ach ieved in 90% (LM, 92%; RCA, 89%; VG, 90%). Quantitative angiographic a nalysis documented an improvement in stenosis diameter from 0.8+/-0.5 mm or 76+/-14% at baseline to 2.1+/-0.6 mm or 36+/-15% at completion ( P<.01). The majority of the acute gain in diameter (1.0+/-0.6 mm) resu lted from ELCA. A major complication during hospitalization occurred i n 3.9% (death, 0%; Q-wave myocardial infarction, 0.5%; bypass surgery, 3.4%). The only logistic regression univariate and multivariate predi ctor of procedure failure was female gender. Six-month angiographic fo llow-up, available in 51% of eligible patients, documented an average lumen diameter of 1.7+/-1.0 mm and mean diameter stenosis of 46+/-26%. Restenosis (>50% diameter stenosis) occurred in 39% (LM, 64%; RCA, 35 %; VG, 35%). Restenosis was less likely when residual stenosis was les s-than-or-equal-to 35% (28% versus 53%, P<.05). Clinical events at fol low-up were death, 2.7%; bypass surgery, 6.5%; myocardial infarction, 2.2%; and repeat angioplasty, 16.2%. Of the remainder, 78% were asympt omatic, class I or II for anginal symptoms. An adverse event during fo llow-up was more than twice as likely in the group with LM (50.0% vers us 21.1%, P<.02). Conclusions. ELCA is acutely effective and safe ther apy in patients with aorto-ostial stenosis. Six-month restenosis, adve rse-event rates were higher and functional status was poorer in the gr oup with LM stenosis. ELCA may be considered as an alternative to bypa ss surgery in carefully selected patients with isolated aorto-ostial s tenosis of the RCA and saphenous vein grafts.