CORONARY PERFORATION AFTER EXCIMER-LASER CORONARY ANGIOPLASTY - THE EXCIMER-LASER CORONARY ANGIOPLASTY REGISTRY EXPERIENCE

Objectives. This study assessed the frequency of perforation with exci mer coronary angioplasty. Background. Coronary artery perforation afte r conventional percutaneous transluminal coronary angioplasty is extre mely rare. Because laser coronary angioplasty involves actual tissue a blation, it has an increased potential for perforation. Methods. All p atients in the Excimer Laser Coronary Angioplasty Registry were includ ed in this prospective study. Those who had a perforation related to t he procedure were compared with those who did not have this complicati on. Results. Of 2,759 consecutive patients in the Excimer Laser Corona ry Angioplasty Registry, 36 (1.3%) had perforation. In these patients, the left anterior descending coronary artery was the most frequently treated vessel (53%). There were no differences in fiber sizes between patients with and those without perforation. Among the patients with perforation, 36.1% required coronary artery bypass surgery, 16.7% expe rienced an infarction and 5.6% had a fatal outcome. Among the patients without perforation, the rates were 3.1%, 3.8% and 0.6%, respectively . However, 41.7% of the patients with documented coronary artery perfo ration did not need coronary artery bypass surgery or experience myoca rdial infarction or death. No angiographic characteristics distinguish ed lesions with from those without perforation. The frequency of coron ary artery perforation declined over time with increasing operator exp erience, from 1.6% in the first 1,888 patients to only 0.4% in the las t 1,000 patients (p = 0.002). Conclusions. With increasing operator ex perience, the rate of perforation with excimer laser coronary angiopla sty has decreased. When perforation occurs, subsequent event rates inc rease.