Treatment of in-stent coronary restenosis with excimer laser angioplasty

Objective To evaluate the efficacy and safety of excimer laser coronary ang ioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-sten t restenosis. Methods ELCA was performed in 20 patients of in-stent restenosis. All patie nts were symptomatic and had class III - IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concen tric) and E (eccentric) with diameter of 1.4-2.0 mm was used. Results Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6 - 51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesion s > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) fro m 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm ( P < 0.0001) and improved the diameter stenosis from 88.8% +/- 10.0% to 46.0% +/- 8.0% (P < 0.0001). Adjunctive ba lloon angioplasty further increased minimal lumen diameter to 2.3 +/- 0.7 m m and reduced diameter stenosis to 14.2% +/- 8.2% (P < 0.0001). At follow-u p (1 - 17 months, mean 8.9 +/- 5.7 months), 17 (85%) patients had remained asymptomatic, 3 (15%) patients had mild to moderate exertional angina, 1 (5 %) patient received CABG. Conclusion ELCA with adjunctive percutaneous transluminal coronary angiopla sty (PTCA) is an efficient and safe technique to debulk tissue in the patie nt with in-stent restenosis. The incidence of procedural related complicati on was low and ELCA may be used as a good method for in-stent restenosis tr eatment.