PATIENT-RELATED AND ANGIOGRAPHIC PREDICTORS OF RESTENOSIS AFTER EXCIMER-LASER CORONARY ANGIOPLASTY

Excimer laser coronary angioplasty (ELCA) is a useful technique for th e treatment of selected complex coronary lesions. However, this techno logy has been limited by significant restenosis and, to date, predicto rs of restenosis after use of this device are not clearly defined. In order to determine predictors of restenosis after ELCA, 43 lesions pre senting with restenosis (> 50% diameter stenosis) at angiographic foll ow-up were compared to 46 lesions without restenosis, based on patient -related, qualitative and quantitative angiographic parameters. Univar iate analysis revealed 9 variables with at least a borderline (p < 0.1 5) significant relation to restenosis: (1) age (p = 0.0759), (2) proxi mal left anterior descending site (p = 0.074), (3) presence of a reste notic lesion (p = 0.104), (4) lesion length (p = 0.0034), (5) referenc e diameter of the treated vessel (p = 0.0076), (6) post laser minimal luminal diameter (MLD) (p = 0.1160), (7) post-procedural MLD (p = 0.00 01), (8) past-procedural stenosis (p = 0.0250) and (9) total procedura l gain (p = 0.0051). After entering stepwise logistic regression analy sis, only 3 variables emerged as independent predictors of restenosis: treatment of a restenotic lesion (p = 0.0255), lesion length (p = 0.0 291) and post-procedural MLD (p = 0.0007). Based on these data, we con clude that post-procedural MLD is the most important predictor of rest enosis after ELCA. Lesion length and the treatment of restenotic lesio ns are also independently associated with an increased risk of resteno sis after ELCA. Therefore, achieving the best possible luminal result at the time of the first intervention should be the goal of the proced ure, especially when treating high restenosis risk lesions.