Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry

In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alo ne, has an angiographic recurrence rate of 30%-85%. Ablating the hypertroph ic neointimal tissue prior to PTCA is an attractive alternative, yet the la te outcomes of such treatment have not been fully determined. This multicen ter case control study assessed the angiographic and clinical outcomes of 1 57 consecutive procedures in 146 patients with ISR at nine institutions tre ated with either PTCA alone (n = 64) or excimer laser assisted coronary ang ioplasty (ELCA, n = 93)) for ISR. Demographics were similar except more uns table angina at presentation in ELCA-treated patients (74.5% vs. 63.5%; P = 0.141). Lesions selected for ELCA were longer (16.8 +/- 11.2 mm vs. 11.2 /- 8.6 mm; P < 0.001), more complex (ACC/AHA type C: 35.1% vs. 13.6%; P < 0 .001), and with compromised antegrade flow (TIMI flow < 3: 18.9% vs. 4.5%; P = 0.008) compared to PTCA-treated patients. ELCA-treated patients had sim ilar rate of procedural success [93 (98.9% vs. 62 (98.4%); P = 1.0] and maj or clinical complications [1 (1.1%) vs. 1 (1.6%); P = 1.0]. At 30 days, rep eat target site coronary intervention was lower in ELCA-treated patients (1 .1% vs. 6.4% in PTCA-treated patients; P = 0.158), but not significantly so . At 1 year, ELCA-treated patients had similar rate of major cardiac events (39.1% vs. 45.2%; P = 0.456) and target lesion revascularization (30.0% vs . 32.3%; P = 0.646). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as balloon angioplasty alone. Despite higher lesion complexity in ELCA-treated patients, no increase in e vent rates was observed. Future studies should evaluate the relative benefi t of ELCA over PTCA alone for the prevention of symptom recurrence specific ally in patients with complex in-stent restenosis. Cathet Cardiovasc Interv ent 2001;52:24-34. (C) 2001 Wiley-Liss, Inc.