ACUTE COMPLICATIONS OF EXCIMER-LASER CORONARY ANGIOPLASTY - A DETAILED ANALYSIS OF MULTICENTER RESULTS

Objectives. The aim of this study was to document and analyze the inci dence and consequences of complications of excimer laser coronary angi oplasty. Background. Excimer laser coronary angioplasty has been repor ted to be a safe and feasible alternative or adjunct to conventional b alloon angioplasty, but serious and unique complications have been obs erved. Methods. Data on 1,595 interventions of excimer laser coronary angioplasty in 1,521 patients were analyzed, using a merged data base from the U.S. and European Percutaneous Excimer Laser Coronary Angiopl asty (PELCA) registries. Results. Procedural success was achieved in 8 9.3% of interven tions. Stand-alone laser angioplasty was performed in 17.8% of interventions. Complications included dissection (22.0%), va so-spasm (6.1%), filling defects (4.8%), abrupt reclosure (6.1%), embo lization (2.3%), perforation (2.4%), arrhythmia (0.7%) and aneurysm fo rmation (0.3%). Major complications were non-Q wave myocardial infarct ion (2.3%), Q wave myocardial infarction (1.0%), coronary artery bypas s grafting (3.1%) and death (0.7%). Logistic regression analysis revea led correlation between dissections and the use of larger catheter siz e (p = 0.0005), high energy per pulse levels (p = 0.0001 for native ve ssels), lesion length > 10 mm (p = 0.001) and presence of a side branc h (p = 0.01). The incidence of perforations was higher in women (p 0.0 04), in treatment of total occlusions (p = 0.02) and in the presence o f a side branch (p = 0.03). Fatal complications were correlated with p atients with multivessel disease (p < 0.0001), patients with acute myo cardial infarction (p = 0.0009) and older patients (> 70 years old, p = 0.004). The incidence of major complications decreased after perform ance of 50 laser angioplasty procedures at one institution (p = 0.02). Conclusions. This analysis defines both the learning curve and the pr ofile of complications for excimer laser angioplasty and provides insi ght into the selection of appropriate patients and proper performance of the procedure.